RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXX	CASE: PD-2017-02895
BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20061224

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Health Care Specialist, medically separated for “low back pain” with a disability rating of 0%.

CI CONTENTION: Given a higher VA rating for the back condition and service connection for irritable bowel syndrome and mental health condition.  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 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 – 2006113	VARD – 20080115	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Low Back Pain	5237	0%	Degenerative Changes of the Thoracolumbar Spine	5242	20%	20071108	
Irritable Bowel Syndrome	Not Unfitting	Irritable Bowel Syndrome (IBS)	7319	10%	20071108	
Depression	Not Unfitting	PTSD	9411	30%	20071220	
COMBINED RATING: 0%	COMBINED RATING OF ALL VA CONDITIONS: 60%	

ANALYSIS SUMMARY:

Low Back Pain (LBP). According to the service treatment record and MEB narrative summary (NARSUM), the CI initially injured his back in July 2004 when he picked up a litter, and his LBP waxed and waned with numbness and tingling to the bilateral buttocks. In July 2006, he was involved in a motor vehicle accident and MRI studies in September 2006 showed mild lumbar spine degenerative changes but no disc herniation. The 21 September 2006 MEB NARSUM examination, 3 months prior to separation, noted complaints midline back pain and numbness and tingling to both legs. Thoracolumbar flexion was to 35 degrees (normal 90) and combined range of motion (ROM) was 125 degrees (normal 240) after repetition, limited by pain.

At the 20 December 2008 VA Compensation and Pension (C&P) examination, 12 months after separation, the CI reported back pain which radiated down the right leg. He could walk approximately one quarter mile before LBP started to hurt, and experienced fatigue with lifting,

carrying, bending, or twisting. He did not use any assistive device or brace, took “mild pain medications,” and denied any incapacitating episodes. He was enrolled in college and had not missed any classes due to the LBP. Physical examination showed lumbar spine and sacroiliac joint tenderness but was able to stand on his toes and heels. Back ROM measurements showed flexion of 40 degrees and combined ROM of 120 degrees after repetition, limited by pain.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the back condition 0%, coded 5237 (lumbar spine strain), citing motion limited by pain and no tenderness or spasms. The VA rated the back condition 20%, coded 5242 (degenerative arthritis of the spine), based on the C&P examination, citing thoracolumbar forward flexion limited to more than 30 degrees but not greater than 60 degrees. Panel members agreed that a 20% rating, but no higher, was justified for limitation of flexion as reported on the NARSUM and VA examinations. There was no evidence of intervertebral disc syndrome which resulted in incapacitating episodes to warrant consideration of rating under that alternate formula. 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 back condition, coded 5242.

Contended PEB Conditions: IBS and Depression. The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting. The contended conditions were not profiled or implicated in the commander’s statement, and did not fail retention standards. There was no evidence of a mental health condition warranting disposition through medical channels, and no performance-based evidence from the record that either 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 the contended conditions, so no additional disability ratings are recommended.

BOARD FINDINGS: In the matter of the back condition, the panel recommends a disability rating of 20%, coded 5242 IAW VASRD §4.71a. In the matter of the contended conditions, the panel recommends no change from the PEB determinations 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	
Low Back Pain	5243	20%	

The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20170327, w/atchs Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

PD-2017-02895

AR20190015556, XXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXX

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. 

2	PD-2017-02895