RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02703
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080118

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Infantryman, medically separated for “chronic low back pain secondary to thoracolumbar strain” 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 - 20071129	VARD - 20080421	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain… 	5237	10%	Lumbar Disc Disease; Chronic Back Strain and Spasm	5242	20%	20080408	
Mild Hyperglycemia	Not Unfitting	No VA Placement	
Mild Hyperlipidemia	Not Unfitting		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain (LBP). According to the service treatment record and MEB narrative summary (NARSUM), the CI’s LBP began in July 2006 after he attempted to jump over a wall while deployed to Iraq.  He subsequently had repetitive strain injuries, and a lumbar spine MRI showed degenerative disc disease at L4-5 and L5-S1, a large disc bulge at L4-5, and moderate to severe spinal canal narrowing.  At a 3 July 2007 physical therapy appointment, range of motion (ROM) measurements showed “50% reduced lumbar flexion [~ 45 degrees]” with mild tenderness and no spasm.  Gait, posture, and neurological findings were normal.  

The 1 November 2007 MEB NARSUM examination, 2 months prior to separation, recorded CI complaints of daily pain with normal activity and intermittent radiation of pain into the left leg.  Physical examination revealed mild tenderness along the spinous processes from the L2-S1 levels, but no spasm in the lumbar paraspinous regions.  The examiner recorded 2 of 8 Waddell's signs (a non-organic component to pain).  Repetitive thoracolumbar ROM tests showed flexion of 40 degrees (normal 90) and combined ROM of 180 degrees (normal 240), with mild pain.   

At the 8 April 2008 VA Compensation and Pension (C&P) examination, 3 months after separation, the CI reported moderate daily back pain.  The examiner noted a normal gait, but muscle spasm severe enough to cause lumbar flattening, and guarding with tenderness and loss of motion.  Thoracolumbar flexion was to 40 degrees with a combined ROM of 125 and painful motion.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the LBP 10%, coded 5237 (lumbosacral strain), citing flexion limited by pain to 45 degrees with back tenderness.  The VA rated the LBP 20%, coded 5242 (degenerative arthritis of the spine), based on the C&P examination, citing thoracolumbar flexion greater than 30 degrees but not, greater than 60 degrees.  Members agreed that a 20% rating, but no higher, was justified for limitation of flexion as reported on the MEB NARSUM and VA examinations.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 20% for the LBP, coded 5237.  

Contended Conditions:  Mild Hyperglycemia and Mild Hyperlipidemia.  The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting.  None of the conditions were profiled or implicated in the commander’s statement, and did not fail retention standards.  There was no performance-based evidence from the record that any of the conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions, so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the low back pain condition, the panel recommends a disability rating of 20%, coded 5237 IAW VASRD §4.17a.  In the matter of the contended mild hyperglycemia and hyperlipidemia conditions, the panel recommends no change from the PEB determinations as not unfitting.  

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

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Low Back Pain Secondary to Thoracolumbar Strain	5237	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170228, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20190006922, 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.