RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXXXX	CASE: PD-2017-02679
BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20090707

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

CI CONTENTION: “I feel my rating should be changed considering the fact I was rated for pain, and not an injury. I've also met other individuals with similar injuries who were rated higher.” 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 - 20090416	VARD - 20090730	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Back Pain	5299-5237	10%	Degenerative Disc Disease with Protrusion and Strain, Thoracolumbar Spine	5243	10%	20090415	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 30%	

ANALYSIS SUMMARY:

Back Pain. According to the service treatment record and MEB narrative summary (NARSUM), the CI’s back condition began in 2004 with no specific injury or incident. An MRI on 31 October 2004, showed a shallow broad-based disc bulge at L4-5 with facet hypertrophy greater on the left than the right, and also a disc bulge at L5-S1 centrally with contact on the thecal sac. An MRI dated 25 August 2008 showed broad-based disc bulges and a central disc protrusion compressing the thecal sac and contacting the nerve roots at L5-S1.

The 17 March 2009 MEB NARSUM examination, 4 months prior to separation, noted CI complaints of chronic low back pain, with flare-ups approximately twice a week. He also reported increased pain with prolonged sitting, standing, repeated bending and heavy lifting. Physical examination showed tenderness to pressure over the central L5-S1 area without palpable spasm. Thoracolumbar range of motion (ROM) measurements recorded active flexion to 70 degrees (normal 90) and combined ROM of 185 degrees (normal 240) after repetition, with painful motion in all planes. The examiner noted a normal gait and posture but stiff movement.

At the 15 April 2009 VA Compensation and Pension (C&P) examination, 3 months before separation, the CI reported low back pain. Physical examination showed a mild lumbar curve reversal and no radiculitis signs or symptoms. Thoracolumbar ROM measurements recorded active flexion to 80 degrees (normal 90) and combined ROM of 200 degrees (normal 240), after repetition, and were 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 5299-5237 (lumbosacral strain), citing tenderness and forward flexion to 70 degrees The VA also rated the back condition 10%, but coded 5242 (degenerative arthritis of the spine), based on the C&P examination, citing thoracolumbar forward flexion to 80 degrees. Panel members agreed that a 10% rating, but no higher, was justified for limitation of flexion (greater than 60 degrees but not greater than 85 degrees), as reported on the NARSUM and VA examinations. 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 rating under that alternate VASRD 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 back condition.

BOARD FINDINGS: In the matter of the 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 20170322, w/atchs Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

2	PD-2017-02679

AR20190008403, 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.