RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX		CASE: PD-2017-02655 BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20060819

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Motor Transport Operator, medically separated for “chronic low back pain” 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 - 20060607	VARD - 20070227	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5299-5237	10%	T7-10 Degenerative Disc Disease with Bulging L5-S1 Disc…	5242	10%	20070108	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 20%	

ANALYSIS SUMMARY:

Chronic Low Back Pain (LBP). According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s LBP began after ruck marching during basic training in 2003. He treated the pain with anti-inflammatory medication, but the pain continued intermittently, and worsened while deployed. Lumbar spine X-rays showed mild scoliosis and degenerative joint and disc disease, and an MRI showed degenerative disc disease without spinal canal or neuroforminal (area through which the spinal nerves exit) stenosis, except at L5-S1 where there was slight narrowing of the neuroforamina bilaterally, greater on the right. At a neurosurgical consult on 22 February 2006, the CI reported back pain which had worsened in the last year, and radiating

“pins and needles” in the left leg; denied any weakness. Physical examination showed back extension and rotation limited by pain, and normal reflexes.  Surgery was not recommended.

The 3 April 2006 MEB NARSUM examination, 5 months prior to separation, noted CI complaints of constant mid-back pain, exacerbated by prolonged sitting, standing, walking or driving, sit-ups, lifting, bending, and wearing protective individual body armor. Upon physical examination, the CI walked with an antalgic gait, and the lumbosacral spine exhibited tenderness but no muscle spasms. Straight leg raise (SLR) tests to elicit radicular symptoms were negative, and neurologic findings were normal. Thoracolumbar range of motion (ROM) measurements, using an inclinometer, showed active flexion to 115 degrees (normal 90) and combined ROM of 240 degrees (normal) after repetition.  There was painful motion with back extension and rotation.

At the 8 January 2007 VA Compensation and Pension (C&P) joints examination, 5 months after separation, the CI reported daily pain, rated at 3/10, which increased without apparent cause, and traveled down the back of the left lower extremity to the foot without numbness or tingling. He denied any incapacitating episodes in the past year. Physical examination revealed a minimal limp favoring the left, which the CI believed was due to his hip, but no tenderness or muscle spasm. Strength and reflexes were normal and a seated SLR test was negative. Using a goniometer, the examiner recorded active thoracolumbar flexion of 95 degrees and combined ROM of 225 degrees after repetitive motion, all associated with painful motion.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the back condition 10%, analogously coded 5237 (lumbosacral strain), citing tenderness with full ROM. The VA also rated the back condition 10%, but coded 5242 (degenerative arthritis of the spine), based on the C&P examination, citing pain at the terminal degrees of all motions. Although there was insufficient limitation of motion to support a 10% rating, panel members agreed a 10% rating was justified for the presence of painful motion and tenderness. 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 intervertebral disc syndrome which resulted in incapacitating episodes requiring physician-prescribed bed rest to warrant consideration of that alternate formula. 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 condition.

BOARD FINDINGS: In the matter of the chronic low back pain 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 20170321, w/atchs Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

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AR20190008400, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed Mr. Russell Blose's application and found his separation disability rating and 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 his 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.