RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02546
BRANCH OF SERVICE:  army	SEPARATION DATE:  20060121

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a Reserve E5, Unit Supply Specialist, medically separated for “chronic back pain” with a disability rating of 20%.

CI CONTENTION:  “I believe my evaluation was handled in an expedited manner.”  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 Physical Evaluation Board (PEB) to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the Medical Evaluation Board (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 - 20051011	VARD - 20061229	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Back Pain	5243	20%	Lumbosacral Strain…	5237	40%	20060914	
			Radiculopathy, Right Lower Extremity	8620	10%	20060822	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:

Chronic Back Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI had intermittent low back pain (LBP) since 1998, which was aggravated while lifting heavy objects during a deployment to Kuwait from 2002 to 2003, and after redeployment in April 2005.  MRI showed a herniated disc with an annular tear at L5-S1.  The CI underwent a right L5‑S1 minimally invasive semi-hemilaminectomy and discectomy microsurgical dissection in 16 June 2005 (7 months before separation).  His LBP continued and he only had rare right foot numbness and tingling. 

The 15 September 2005 MEB physical therapy (PT) examination, 3 months after surgery and 4 months before separation, revealed thoracolumbar range of motion (ROM) of flexion to 40 degrees (normal 90) and combined ROM of 140 (normal 240).  Painful motion was present.  

At the 19 September 2005 MEB NARSUM examination the CI reported back pain.  Physical examination revealed an antalgic gait and spinal tenderness but no spasm.  The examiner referenced the aforementioned MEB PT ROM examination.  Pain rating was slight/constant per AMA pain rating scale.  He had no history of falls or unsteadiness and was actually independent in self-care and activities of daily living.  He was not working due to back pain.

At the 14 September 2006 VA Compensation and Pension (C&P) spine examination, 15 months after surgery and 8 months after separation, the CI reported LBP and said he could walk for 10-30 minutes.  Physical examination showed a normal posture.  The CI walked without any assistive devices and was not using a lumbosacral orthosis.  There was tenderness on the lumbosacral spine paravertebral muscles, accompanied by spasms.  He showed some limitation to perform below-waist activities.  The spine showed a reverse lordosis.  Thoracolumbar flexion was 10 degrees and combined ROM was 85 degrees; painful motion was elicited.  Motor examination did not show any lower extremity atrophy or impairment.  There was decreased pin‑prick sensation in the right leg at the L4-L5 and L5-S1 dermatome.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 20%, coded 5243 (intervertebral disc syndrome (IVDS)), citing thoracolumbar ROM (performed 3 months status post-surgery) limited by pain.  The VA rated the back condition 40%, coded 5237 (lumbosacral strain),and radiculopathy, right lower extremity 10%, coded 8620, based on the C&P Spine examination citing limitation of flexion.  

The panel agreed a 20% rating, but no higher, was justified for limitation of flexion (greater than 30 degrees but not greater than 60 degrees), as reported on the MEB PT ROM examination most proximate to separation.  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 back condition.

BOARD FINDINGS:  In the matter of the back 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 20170316, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR20180015183, 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.