RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02565
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20061106

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Abrams Tank System Maintainer, medically separated for “chronic back pain due to lumbar degenerative disc disease [DDD] without neurologic abnormality” with a disability rating of 10%.   

CI CONTENTION:  No specific contention was made.  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 – 20060925	VARD - 20070606	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Back Pain	5299-5242	10%	Lumbar DDD with Sacroiliac Sprain	5242	20%	20070327	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Chronic Back Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI reported a 3-year history of back pain without injury or trauma.  An MRI on 11 April 2006 revealed mild DD at L5-S1 and a chronic wedge deformity of the L2 vertebra, and he was treated conservatively with chiropractic care, anti-inflammatories, muscle relaxants, activity modification and pain medication.  At the 18 July 2006 MEB physical therapy (PT) ROM evaluation, 4 months prior to separation, thoracolumbar range of motion (ROM) measurements showed flexion of 35 degrees (normal 90) and combined ROM of 140 degrees (normal 240), after three repetitions and limited by pain.  During the 14 July 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), the examiner noted a normal gait, but lumbosacral paraspinal tenderness and painful, decreased ROM (not quantified).  The 24 August 2006 MEB NARSUM examination, 2 months before separation, noted CI complaints of constant low back pain aggravated by sitting, standing, bending, twisting, lifting and impact activities.  Physical examination showed no paraspinal muscle spasms or tenderness.  Strength, sensation, and reflexes were normal and maneuvers to elicit radicular symptoms were negative.  

At the 27 March 2007 VA Compensation and Pension (C&P) examination, 5 months after separation, the CI reported constant back pain since January 2003.  Physical examination showed a normal gait and posture.  There was no evidence of radiating pain on movement and no muscle spasms, however tenderness was noted.  Thoracolumbar flexion was to 40 degrees and combined ROM was150 degrees, with ROM not additionally limited by pain, fatigue, weakness, lack of endurance or incoordination after repetition  There were no signs of intervertebral disc syndrome (IVDS) with chronic and permanent nerve root involvement.  Thoracic spine X-rays were normal, but lumbar X-rays showed an old L2 vertebral fracture with a 10% height loss.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, analogously coded 5299-5242 (degenerative arthritis of the spine), citing thoracolumbar ROM limited by pain with localized tenderness.  The VA rated the back condition 20%, coded 5242 based on the C&P examination, citing forward flexion limited to 40 degrees.  Panel members agreed that 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 and VA examinations.  There was no documentation of IVDS with incapacitating episodes which would provide for a higher rating under that formula.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 20% for the back condition, coded 5299-5242.  

BOARD FINDINGS:  In the matter of the back condition, the panel recommends a disability rating of 20%, coded 5299-5242 IAW VASRD §4.71a.  There are no other conditions within the panel’s scope of review for consideration.  

The panel recommends the CI’s prior determination be modified as follows, effective the date of medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Back Pain due to Lumbar Degenerative Disc Disease	5299-5242	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170215, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20190007577, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

DearXXXXXXXXXXXXXXXXXX

The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	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. 

	A copy of this decision has also been provided to the Department of Veterans Affairs.