RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02940
BRANCH OF SERVICE:  ARMY	SEPARATION DATE:  20060407

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a National Guard E6, Signal Support Systems Specialists, medically separated for “chronic back pain” with a disability rating of 10%.  

CI CONTENTION:  Review of all conditions requested.  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 - 20060221	VARD - 20060627	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Back Pain	5299-5242	10%	Degenerative Disc Disease L4-5 and L5-S 1	5243	10%	20060106	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Chronic Back Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s back condition initially began after a weekend drill in 1999 or 2000.  No specific trauma or incident was noted.  An MRI showed a herniated disc.  The NARSUM examiner wrote, “He was treated with epidural shots and state[d] his symptoms resolved.”  In October 2004, his symptoms were exacerbated while running and jumping.  His symptoms improved until June 2005 when they increased after walking with body armor and other gear.  An MRI in September of 2005 revealed a disc herniation at L4-5 and L5-S1.  Electrophysiologic studies in January 2006 showed no evidence of a radiculopathy.  He was not a surgical candidate. 

At the 6 January 2006 VA Compensation and Pension (C&P) examination, 3 months before separation, the CI reported back pain which occurred six times per day and lasted for about 1 hour each time.  He characterized the 4/10 pain as burning and sharp in nature.  The pain was elicited by sitting for long periods or carrying heavy objects on his back.  He related incapacitating episodes as often as once per year lasting 3 days.  Physical examination showed gait and posture to be within normal limits.  Examination of the thoracolumbar spine revealed no complaints of radiating pain on movement, but there were muscle spasms and tenderness.  Straight leg raise testing was negative and there was no ankylosis of the spine.  The range of motion (ROM) study showed painful flexion of 65 degrees (normal 90) and combined ROM of 190 degrees (normal 240), after repetitive motion.  

The 30 January 2006 MEB NARSUM examination, 2 months prior to separation, noted complaints of 1/10 low back pain aggravated by leaning over while sitting, or prolonged standing or sitting.  He stated he was unable to carry weight on his body or run.  Physical examination showed tenderness in the lower lumbar area and a positive seated straight leg raise test.  Muscle strength and reflexes of the lower extremities were normal.  The ROM test showed flexion greater than 90 degrees and combined ROM of 230 degrees with pain.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, analogously coded 5299-5242 (degenerative arthritis of the spine), citing tenderness.  The VA rated the back condition 10%, coded 5243 (intervertebral disc syndrome [IVDS]), based on the STR and C&P examination, citing limitation of motion.  The panel agreed that a 10% rating, but no higher, was justified for limitation of flexion (greater than 60 degrees but not greater than 85 degrees) or combined ROM (greater than 120 degrees but not greater than 235 degrees), as reported on the MEB NARSUM and VA C&P examinations.  There was no muscle spasm or guarding severe enough to result in an abnormal gait or spinal contour, thus the next higher 20% rating was not justified on this basis.  The panel considered whether a higher rating (§4.7) was achieved by using the alternate rating formula based on incapacitating episodes due to IVDS.  The evidence showed the CI had IVDS and experienced incapacitating episodes due to acute signs and symptoms that required treatment and bed rest prescribed by a physician.  According to review of the STR, the total duration of incapacitation over the 12 months prior to separation was at least 1 week but less than 2 weeks, supporting a 10% rating, however this did not result in a rating higher than the PEB rating.  After due deliberation, considering all 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 back 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 20170328, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20190007213, 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.

A copy of this decision has been provided to the counsel you listed on your application,