RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME: XXXXXXXXXXXXXXXXXX	CASE: PD-2017-02610
BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20070215

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Cable Systems Installer-Maintainer, medically separated for “low back pain and radiating back pain” with a disability rating of 10%.

CI CONTENTION:  “Review all conditions.”  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 - 20061208	VARD - 20070706	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain and Radiating Back Pain	5299-5237	10%	Lumbar Strain	5237	10%	20070315	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 10%	

ANALYSIS SUMMARY:

Chronic Low Back Pain and Radiating Back Pain. According to the service treatment record and MEB narrative summary (NARSUM), the CI’s low back condition began insidiously around September 2002 while deployed. A lumbar spine MRI in November 2005 showed an L5-S1 broad- based disc protrusion displacing and compressing the right S1 nerve root, as well as an L4-5 disc bulge.   The  CI also had  pain radiating into the  legs with some numbness and tingling.   The    14 September 2006 physical therapy evaluation, 5 months prior to separation, recorded thoracolumbar range of motion (ROM) measurements showing forward flexion to 45 degrees (normal 90) and a combined ROM of 190 degrees (normal 240), with painful motion.         At the

19 September 2006 MEB NARSUM examination, the CI reported chronic low back pain that was approximately 70% located in the back with 30% in the legs. In addition to this pain, he experience burning, stinging and numbness, and his symptoms were exacerbated by prolonged sitting, standing, lifting, or bending. Physical examination was recorded as “essentially within normal limits.” The examiner indicated that a spine and neurosurgery evaluation in May 2006 was unremarkable.

During the 15 March 2007 VA Compensation and Pension (C&P) examination, 1 month after separation, the CI reported significantly improved pain, which was still constant but did not radiate. He had not required physician prescribed bedrest, had no numbness, weakness or decreased sensation, and no longer required pain medication. Walking helped the back pain, but he was unable to stand or sit for more than an hour; he had not worked since service discharge. The examiner noted normal back contour and posture with no tenderness or muscle spasm. Upper and lower extremity strength was normal, and reflexes intact. Thoracolumbar forward flexion was to 90 degrees, with pain, and combined ROM was 225 degrees.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the low back condition 10%, analogously coded 5237 (lumbosacral strain), citing tenderness and flexion of 81 degrees and extension of 30 degrees, limited by pain. The VA also rated the low back condition 10%, coded 5237, based on the C&P examination, citing discomfort with motion. Panel members agreed that a 10% rating was justified for limitation of combined motion greater than 120 degrees but not greater than 235 degrees, as reported on the physical therapy and C&P examinations. The C&P examination recorded full thoracolumbar flexion and the absence of radicular symptoms, and there was no documentation of intervertebral disc syndrome with incapacitating episodes which would provide for a higher rating under that formula. Although the CI reported radiating back pain into his lower extremities, this pain is subsumed under the general spine rating criteria, which specifically states “with or without symptoms such as pain (whether or not it radiates).” There was no objective evidence of a radiculopathy with functional impairment (such as weakness) that directly impacted fitness for duty. The panel therefore concluded that an additional disability rating was not justified on this basis. 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 low back pain condition.

BOARD FINDINGS: In the matter of the low 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 20170308, w/atchs Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

2	PD-2017-02610

AR20190008545, 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.