RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02943
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060119

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Chaplain Assistant, medically separated for “chronic low back pain” with a disability rating of 10%.   

CI CONTENTION: Two applications were submitted with the first requesting “increase disability rating,” and the second stating “service connected conditions have worsened.”   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 - 20050906	VARD - 20060811	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5237	10%	Degenerative Joint/Disc Disease, Lumbar Spine	5242	10%	20060227	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  70% 	

ANALYSIS SUMMARY:  
 
Chronic Low Back Pain (LBP).  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s chronic LBP condition began after a motor vehicle accident in 1997 and a subsequent training accident in September 2004.  On 1 October 2004, the CI reported an acute LBP exacerbation that was treated with stretching and medication.  On 26 October 2004, X-rays demonstrated multilevel discogenic degenerative changes from T11- L5 with straightening and loss of the normal lumbar lordosis.  Physical therapy was started in October 2004 and continued through December 2004.  Magnetic resonance imaging (MRI) of the lumbar spine on 24 January 2005 showed desiccated discs at L2-3 through L4-5 levels, Schmorl’s nodes at multiple levels, and bilateral facet hypertrophy with mild to moderate neural foraminal narrowing without evidence of nerve root compression.  The orthopedic evaluation on 16 March 2005 revealed tenderness along the paraspinal muscles and full thoracolumbar range of motion (ROM) with painful flexion, which was limited “to fingers at the level of the knees.”  The lumbosacral spine also exhibited painful motion with lateral bending.  Straight leg raise testing (to determine nerve root irritation) was negative.  No muscle spasms were present.  

At the 16 March 2005 MEB NARSUM examination, 10 months prior to separation, the CI complained of LBP.  Physical examination showed normal posture and gait, diffuse tenderness along the thoracic and lumbar paraspinal muscles, and “full active ROM with pain in flexion limiting his reach to about 18 inches from the ground and also with right and left lateral bending.”  Neurologic testing was unremarkable except for two to three beats of clonus (muscle spasms with often rhythmic contractions) with a negative Babinski bilaterally.  In a MEB addendum dated 4 May 2005, 8 months before separation, three active ROM measurements were recorded using an inclinometer and showed flexion to 60 degrees (normal 90) with a combined ROM of 200 degrees (normal 240).  There was moderate pain and guarding in the lumbar area during flexion and bilateral lateral bending.  Passive flexion was reported to be 70 degrees.  

At an outpatient clinic visit on 19 September 2005, the CI had a normal gait and back tenderness with moderate ROM restriction.  The examiner noted no clear radiculopathy, but that strength was “diffusely decreased in the right leg, probably limited by pain,” and that sensation was also decreased due to pain and during light touch on the right leg and sacral dermatomes.  

At the 27 February 2006 VA Compensation and Pension (C&P) examination, 1 month after separation, the CI reported stiffness and weakness with an inability to bend.  He had difficulty walking due to constant back pain that was aching and sharp in nature (rated at 9/10), and radiated down both legs.  The pain was relieved by medication which allowed him to function, and he denied incapacitation, lost time from work, or use of an assistive device for ambulation.  Physical examination showed a normal posture and gait as well as neurologic findings.  Tenderness was present on the lumbar spine, but bilateral SLR testing was negative.  Measured ROM showed flexion to 80 degrees, with pain, and a combined ROM of 210 degrees.  Pain was the only limiting factor after repetition, and fatigue, weakness, lack of endurance or incoordination were not evident.  The examiner also noted “no signs of intervertebral disc syndrome with chronic and permanent nerve root involvement.”

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic LBP 10%, coded 5237 (lumbosacral strain), citing over the lumbar spine and a ROM of 70 degrees flexion, limited by pain.  The VA also rated the chronic LBP 10%, coded 5242 (degenerative arthritis of the spine), based on the C&P examination, citing forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or, combined ROM of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees.  Members agreed that a 10% rating, but no higher, was justified for limitation of flexion and combined ROM as reported on the C&P examination, which was more proximate to separation and used VASRD compliant ROM measurements.  There was no documentation 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.    

BOARD FINDINGS:  In the matter of the chronic low 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 20170424 and 20170520, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180008804, 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