RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02817
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070530

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a National Guard E6, Infantryman, medically separated for “chronic 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 - 20070501	VARD - 20080729	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Back Pain	5299-5242	10%	Discogenic Disease	5243	20%	20080305	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Chronic Back Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s back condition was aggravated while training in full battle gear after activation in December 2006.  An MRI showed “degenerative disk disease at T11-12, mild bulge of disk at L4-5, and minimal protrusion of L5-S1 directed centrally and to the left with mild foraminal compromise at this level.”  There was no surgical indication.  

During the 23 January 2007 MEB examination (recorded on DD Forms 2807-1 and 2808), 4 months prior to separation, the CI reported a back injury, and the examiner documented a normal spine with left leg numbness and tingling and a diagnosis “herniated disc at T11/T12.”  At the MEB physical therapy (PT) range of motion (ROM) evaluation on 9 February 2007, the CI reported low back pain, rated at 5/10.  Measured ROM after repetition showed flexion of 80 degrees (normal 90) and a combined ROM of 220 degrees (normal 240), with pain throughout the motion.  There was localized tenderness, but no abnormal gait or spinal contour.    
	
The 23 February 2007 MEB NARSUM examination, 3 months before separation, noted CI complaints of back pain.  Physical examination revealed an antalgic gait on the left as well as tenderness.  Motor strength and reflexes were normal, but sensation was decreased to pinprick over the lateral upper aspect of the left thigh. 

At the 5 March 2008 VA Compensation and Pension (C&P) examination, 9 months after separation, the CI reported left low back pain.  Physical examination revealed normal posture and gait, and no atrophy, guarding, weakness or pain with motion.  There was tenderness and spasm on the left, but muscle strength and reflexes were normal in the lower extremities.  Sensation to light touch was decreased on the left.  Measured ROM after repetition showed  flexion to 70 degrees and a combined ROM of 200 degrees; X-rays studies showed mild degenerative joint disease of the spine.     

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, analogously coded 5242 (degenerative arthritis of the spine), citing ROM limited by pain with localized tenderness.  The VA rated the back condition 20%, coded 5243 (intervertebral disc syndrome), citing painful motion, tenderness, spasms, and no ankylosis.  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) and combined ROM (greater than 120 degrees but not greater than 235 degrees), as reported on the MEB PT ROM and C&P examinations.  Although muscle spasm was reported on the C&P examination, it was not 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 formula.  After due deliberation, considering all of 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 chronic back pain 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 20170422, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180009784, 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.

Sincerely,					      
Enclosure