RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02920
BRANCH OF SERVICE:  army 	SEPARATION DATE:  20060811

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Cable System Installer/Maintainer, medically separated for “chronic low back pain” with a disability rating of 10%.  

CI CONTENTION:  “Depression and I hurt my back digging holes with a two man auger.”  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 - 20060620	VARD - 20070220	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5299-5237	10%	Lumbar Spine Strain	5237	10%	20070201	
Dysthymic Disorder	Not Unfitting	Dysthymic Disorder	9433	10%	20070201	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20% 	

ANALYSIS SUMMARY:  

Chronic Low Back Pain (LBP).  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s low back condition began in early 2005 after building a fence.  Lumbar spine X-rays in November 2005 and an MRI in March 2006 were normal.  Physical therapy (PT) provided only temporary benefit and there was no surgical indication.  

The 11 April 2006 MEB PT range of motion (ROM) study showed, after three repetitions, thoracolumbar flexion to 80 degrees (normal 90) and a combined ROM of 190 degrees (normal 240) with painful motion.  The 3 May 2006 MEB NARSUM examination, 3 months prior to separation, noted complaints of chronic LBP aggravated by activity.  Physical examination showed normal spinal contours and right lumbar muscle tenderness without spasms. 

At the 1 February 2007 VA Compensation and Pension (C&P) evaluation, 6 months after separation, the CI reported constant LBP that radiated to the right sacral area.  He used a back brace, denied incapacitating episodes, and as a cable installer, had not missed any work in the previous year.  Physical examination showed a normal gait and spinal curvature with no tenderness or muscle spasm.  Thoracolumbar ROM was flexion of 70 degrees with combined ROM of 220 degrees and painful motion.  There was no additional loss of motion with repetition.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the LBP condition 10%, analogously coded 5299-5237 (lumbosacral strain), citing tenderness and forward flexion of 85 degrees.  The VA also rated the back condition 10%, coded 5237 (lumbosacral strain), based on the C&P evaluation, citing limitation of motion.  Panel members agreed that a 10% rating, but no higher, was justified for limitation of flexion and combined ROM as reported on the MEB NARSUM and VA examinations.  There was no muscle spasm or guarding severe enough to result in an abnormal gait or spinal contour for a higher 20% rating, and there was no evidence of intervertebral disc syndrome with incapacitating episodes which would provide for a higher rating under that 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 chronic LBP condition.  

Contended PEB Condition:  Dysthymic Disorder.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The contended condition was not profiled, implicated in the commander’s statement or judged to fail retention standards.  At the 19 April 2006 MEB mental health consult, the psychiatrist determined the condition did not limit readiness or worldwide deployability and met psychiatric retention criteria.  There was no evidence from the record that the condition 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 condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the chronic LBP condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended dysthymic disorder condition, 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.  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 20170428, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record  

AR20180006137, 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