RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME: XXXXXXXXXXXXXXXXXXX	CASE: PD-2017-02616
BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20060425

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E7, Human Intelligence Collector, medically separated for “chronic low back pain [LBP] with lumbar degenerative disc disease [DDD]” with a disability rating of 0%.

CI CONTENTION: He was diagnosed with DDD at the time of discharge as a result of service connected disability.  The complete submission is at Exhibit A.

SCOPE OF REVIEW: The panel’s scope of review is defined in Do DI 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 – 20060307	VARD – 20061016	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic LBP	5299-5237	0%	Intervertebral Disc Syndrome (IVDS) with Degenerative Arthritis Changes	5243	20%	20060727	
COMBINED RATING: 0%	COMBINED RATING OF ALL VA CONDITIONS: 80%	

ANALYSIS SUMMARY:

Chronic LBP. According to the service treatment record and MEB narrative summary (NARSUM), the CI first developed LBP in April 1999 without a specific injury or trauma. He was prescribed a nonsteroidal anti-inflammatory drug (NSAID) and the symptoms gradually resolved. He had  another occurrence in April 2002 with recurring intermittent LBP until the summer of 2005, when experienced a "more severe" episode, which made it difficult to straighten the back. He was then given a temporary profile and referred for physical therapy and chiropractic treatment. Although he benefitted from both, he stated that he could not do as much as before.  On 24 August 2005,

lumbar spine X-rays revealed DDD at L4-L5 and L5-S1 with some mild facet degenerative changes. During an orthopedic evaluation, the provider determined that he was not a surgical candidate and issued a permanent L-3 profile. At a follow-up visit, he was diagnosed with mechanical lower back pain with DDD of the lumbar spine.

During the 29 December 2005 MEB examination (recorded on DD Forms 2807-1 and 2808), 4 months prior to separation, the CI reported sharp LBP that restricted movement and radiated to the knees. Physical examination showed no joint or spinous process tenderness, and measured thoracolumbar range of motion (ROM) revealed flexion to 75 degrees (normal 90) and a combined ROM of 170 degrees (normal 240), with pain.

The 6 February 2006 MEB NARSUM examination, 2 months before separation, noted CI complaints of constant pain all across the lower lumbar area, and occasional radiation into the left posterior thigh. Back pain was aggravated by lifting, running and prolonged stand and sitting, but he denied bowel and bladder disturbances. The pain improved with heat and rest, and did not require medication. Physical examination revealed normal posture and gait with no difficulty during heel and toe walking. There was no lumbar spine tenderness, spasm or deformity, and straight leg raise tests were negative bilaterally. Deep tendon reflexes were +1 and symmetrical in the lower extremities, with no motor or sensory deficits; pedal pulses were +2 and symmetrical. Active ROM measurements using a goniometer revealed forward flexion to 70 degrees, extension to 30 degrees (normal) and a combined ROM of 230 degrees, with pain in all planes except for right lateral rotation.

At the 27 July 2006 VA Compensation and Pension (C&P) examination, 3 months after separation, the CI reported constant LBP which traveled to/from the left knee and left hip to the right hip. He was taking a NSAID and endorsed incapacitating episodes as often as 2 times a month, which lasted for 13 days (over the past year, he related two incidents of incapacitation for a total of 26 days). Physical examination revealed a normal gait, but decreased ROM with pain, tenderness and spasm, and lower left extremity radicular symptoms.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the low back condition 0%, coded 5237 (Lumbosacral strain), citing normal posture, gait and movement, and motion slightly limited by pain. The VA rated the low back condition 20%, analogously coded 5243 (IVDS), based on the C&P examination, citing limitation of motion and LBP with degenerative changes. Panel members agreed that while there was no limitation of thoracolumbar spine motion to support a 10% rating under the General Rating Formula for Diseases and Injuries of the Spine, all examinations noted the presence of painful motion, and thus a 10% rating was warranted (VASRD 4.59). 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 IVDS which resulted in incapacitating episodes requiring physician-prescribed bed rest to warrant consideration of 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 10% for the low back condition, coded 5237.

BOARD FINDINGS: In the matter of the low back condition, the panel recommends a disability rating of 10%, coded 5237 IAW VASRD §4.59. 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	
Low Back Pain	5237	10%	

AR20190012348, XXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXX

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.