RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02445
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20050718

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Fire Support Specialist, medically separated for “chronic back pain” with a disability rating of 10%.  

CI CONTENTION:  His back condition required surgery after separation. Review of an additional condition not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB) was also requested.  The complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The panel’s scope of review is defined in DoDI 6040.44.  It is limited to review of disability ratings assigned to those conditions determined by the PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the MEB, but determined by the PEB to be not unfitting or non-compensable.  Any conditions outside the panel’s defined scope of review, and any contention not requested in this application, may remain eligible for future consideration by the Board for Correction of Military Records.  The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence relevant to application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards for the unfitting medical condition(s) at the time of separation.  The panel has neither the role nor the authority to compensate for post-separation progression or complications of service-connected conditions; that role and authority is granted by Congress to the Department of Veterans Affairs, which operates under a different set of laws.  The panel gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20050413	VARD - 20051020	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Back Pain, Spondylolisthesis…	5239	10%	Spondylolisthesis L5-S1	5239	0%	20050222	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain (LBP).  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s LBP condition began in April 2003 without history of trauma.  Radiographic workup revealed grade I spondylolisthesis (vertebral slippage) of L5 associated with disc bulging and bilateral nerve impingement.  The CI was treated with medication, physical therapy (PT), and spinal injections without pain relief.  Although offered, he declined neurosurgical options and thus was referred to MEB for adjudication.  
At the 22 February 2005 VA Compensation and Pension (C&P) examination, 5 months prior to separation, the CI reported constant LBP described as aching, sharp, and sticking in nature.  He endorsed the ability to function with medication.  His physical examination (PE) revealed full, but painful spinal motion only in the last 10 degrees of right rotation.  There was no evidence of local tenderness or spinal muscle spasms.  There was an unquantifiable amount of sensory deficit in both lower extremities described as involving the L5 dermatome level, thus indicating positive signs of intervertebral disc syndrome (IVDS).  The examiner further noted that the IVDS did not cause any bowel, bladder or erectile dysfunction.

The 4 April 2005 MEB NARSUM examination, 3 months prior to separation, noted complaints of soreness and increased LBP with prolonged walking or sitting.  He endorsed the inability to do physical training, run, perform sit-ups, or carry more than 20 pounds.  His PE revealed decreased spinal range of motion (ROM) noting forward flexion of 80 degrees (normal 90) and combined ROM of 220 degrees (normal 240).  Lower spine tenderness and bilateral muscle spasms were present.  Straight leg raise test was normal and without pain bilaterally.  Gait and heel and toe walk was normal.  

The panel directed attention to its rating recommendation based on the above evidence.  Both the PEB and VA utilized the same VASRD code of 5239 (spondylolisthesis or segmental instability) and arrived at ratings of 10% and 0%, respectively.  The PEB citied local tenderness, whereas the VA cited full and nearly painless ROM.  The panel concluded there was no evidence to support a rating higher than that adjudicated by the PEB.  Although there was insufficient limitation of motion to support a 10% rating, the panel agreed a 10% rating was justified for the presence of painful motion, tenderness, and spasm.  There was no muscle spasm or guarding severe enough to result in an abnormal gait or spinal contour, thus the next higher 20% rating was not justified on this basis.  There was no evidence of IVDS which resulted in incapacitating episodes requiring physician-prescribed bed rest to warrant consideration of rating under the alternate VASRD formula for that condition.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the LBP condition. 

BOARD FINDINGS:  In the matter of the LBP condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  There are no other conditions within the panel’s scope of review for consideration.  Therefore, the panel recommends no modification or re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170225, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180015176, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction.

Sincerely,					       

Enclosure