RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02774
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20070124

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E2, Basic Trainee, medically separated for “chronic low back pain” with a disability rating of 10%.  

CI CONTENTION:  “In constant daily pain since my accident.”  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 - 20070110	VARD - 20070706	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5237	10%	Residuals, Low Back Injury	5243	20%	20070510	
Mild Radiculopathy	Not Unfitting	Right Lower Extremity Radiculopathy	8520	10%		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:

Chronic Low Back Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s back condition began in July 2006 after falling off an obstacle during basic training.  Radiographic studies revealed mild L4-5 spinal canal narrowing and disk desiccation (dehydration), surgery was not recommended.  During the physical therapy (PT) range of motion (ROM) examination on 2 November 2006, 3 months before separation, goniometric measurements were flexion of 60 degrees (normal 90) and combined ROM of 170 degrees (normal 240), after repetition.   At the 7 March 2007 MEB NARSUM, 2 months prior to separation, the CI reported low back pain.  Physical examination documented spinal tenderness and positive straight leg raising (SLR) test for radiculopathy.  The CI was able to forward flex far enough to touch the front of her knees.  Gait, posture and spinal muscle spasms were not addressed.  

During the 10 May 2007 VA Compensation and Pension (C&P) examination, 4 month after separation, the CI reported 7/10 back pain, radiating to both hips and down the right leg to the foot.  The CI reported that pain increased to the point of dizziness and nausea.  Physical examination revealed a normal gait and posture.  There was moderately severe spinal tenderness and mild muscle spasm.  Painful lumbar ROM was flexion of 50 degrees and combined ROM of 145 degrees.  There was no ROM loss following repetition.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, coded 5237 (lumbosacral strain), citing tenderness.  The VA rated the back condition 20%, coded 5243 (intervertebral disc syndrome (IVDS)), based on the C&P examination, citing limitation of flexion.  Panel members agreed that a 20% rating, but no higher, was justified for limitation of flexion (greater than 30 degrees but not greater than 60 degrees), as recorded on the PT and VA ROM examinations.  There was no documentation of IVDS with incapacitating episodes which would provide for a higher rating under that formula.  The panel also noted the evidence did not support functional impairments (such as weakness) secondary to a lower extremity radiculopathy that significantly interfered with satisfactory duty performance at separation.  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 low back condition, coded 5237.  The panel concluded there was insufficient cause to recommend a change in the PEB adjudication of the radicular condition as not separately unfitting.  

BOARD FINDINGS:  In the matter of the back condition and IAW VASRD §4.71a, the panel recommends a disability rating of 20%, coded 5237 IAW VASRD §4.71a.  In the matter of the contended radiculopathy, the panel recommends no change from the PEB determination as not unfitting.  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	
Chronic Low Back Pain	5237	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170301, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR20190007176, 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.