RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02667
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20060721

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Aviation Operations Specialist, medically separated for “chronic low back pain” with a disability rating of 10%.  

CI CONTENTION:  “I would like for my rating to be updated to reflect the VASRD that was in effect in September 23, 2002-Intervertebral Disc Syndrome.”  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 - 20060409	VARD - 20070110	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5243	10%	Lumbar Spine Degenerative Disc Disease	5242	40%	20061113	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s back condition began in August 2004 after moving furniture.  Neurosurgery established the CI was not a candidate for surgery.    At the 31 August 2004, physical therapy (PT) examination, the CI reported pain with exertion or standing.  Physical examination showed no abnormal gait, no tenderness and no edema.  Lumbar spasm was present.  Strength was normal.  The CI exhibited full thoracolumbar range of motion (ROM).  The examiner noted the CI bent over and touched toes, but experienced difficulty.  The 30 June 2005 PT examination, the CI reported 6/10 low back pain.  Physical examination showed full ROM with lumbar tenderness.  Strength was normal.  X-rays on 24 August 2005 showed a disc herniation and bulge at L4-5 with neural foraminal narrowing and spinal canal stenosis.  There was also a disc bulge at L3-4.  The 20 January 2006 MEB PT ROM examination showed thoracolumbar flexion of 50 degrees (normal 90) and combined ROM of 165 degrees (normal 240) after repetitive motion.  

The 3 February 2006 MEB NARSUM examination, 5 months prior to separation, noted complaints of frequent, severe lower back pain (8-10/10) accompanied by pain that radiated into his lower legs.  Physical examination showed no edema or tenderness.  Motor strength and reflexes were normal and sensory examination was intact.  Patrick sign was positive bilaterally. 

At the 13 November 2006 VA Compensation and Pension (C&P) examination, 4 months after separation, the CI reported constant aching pain across the low back, radiating down both legs.  Physical examination showed a normal gait and posture.  There was mild muscle spasm and tenderness.  Neurologic examination was intact, which included negative straight leg tests.  Thoracolumbar ROM showed flexion of 35 degrees (normal 90) and combined ROM of 155 degrees (normal 240).  Flexion after repetition was 30 degrees and painful motion was noted. 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, coded 5243 (intervertebral disc syndrome), citing combined passive ROM of 223 degrees.  The VA rated the back condition 40%, coded 5242, (degenerative arthritis of the spine), citing evidence of forward flexion of the lumbar spine of 30 degrees following repetition with pain.  

Although the VA examination showed 30 degrees of flexion after repetitive motion, the panel agreed the MEB PT ROM examination carried the most probative valued and supported a 20% rating, but no higher for limitation of flexion (greater than 30 degrees but not greater than 60 degrees).  There was no evidence of intervertebral disc syndrome, which resulted in incapacitating episodes requiring physician-prescribed bed rest to warrant consideration of rating under the alternate VASRD formula for that condition.  Considering the totality of evidence, the panel determined a disability rating of 20% for the back condition is appropriately recommended in this case.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 20% for the low back condition, coded 5243.

BOARD FINDINGS:  In the matter of the back condition, the panel recommends a disability rating of 20%, coded 5243 IAW VASRD §4.71a.  There are no other conditions within the panel’s scope of review for consideration.  

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

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Low Back Pain	5243	20%	

The following documentary evidence was considered:  

Exhibit A.  DD Form 294, dated 20170421, w/atchs  
Exhibit B.  Service Treatment Record  
Exhibit C.  Department of Veterans Affairs Record

AR20180008670, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

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 

Sincerely,					      
Enclosure