RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02944
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070914

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Patriot Missile Systems Operator/Maintainer, medically separated for “chronic low 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 - 20070821	VARD - 20080321	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5299-5243	10%	Herniated Nucleus Pulposus at L4-5 and L5-S1	5243	20%	20071031	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s back condition began in March 2007 without a specific mechanism of injury.  X-rays showed minimal scoliosis centered at the T10 level with convexity to the right.  The radiologist’s impression was minimal lumbar levoscoliosis and suspected mild disc height loss and facet degenerative changes at L5-S1.  An MRI revealed posterior disc bulging at L4-5 and L5-S1, which compressed and narrowed the thecal sac and central canal at two levels.  Disc bulging abutted the nerve roots within the inferolateral foramina at the same levels.  The examiner opined it was probable early disc degeneration at L4-5.  
The 18 July 2007 MEB NARSUM examination, 2 months prior to separation, noted complaints of chronic 8/10 back pain with flares to 10/10, which limited his ability to do any vigorous activity outside of walking.  Physical examination showed tenderness.  Muscle strength, sensation, and reflexes were normal in the upper and lower extremities.  Lumbar spine range of motion (ROM) was limited due to pain.  Thoracolumbar ROM measurements performed by physical therapy (PT) on 6 August 2007, one month prior to separation, showed flexion of 35 degrees (normal 90) and combined ROM of 125 degrees (normal 240), after repetition.  There was significant muscle tightness and visible guarding.  

At the 31 October 2007 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported chronic 5-6/10 back pain.  Physical examination showed normal gait and posture, but there was tenderness and muscle spasm.  The neurologic evaluation was normal.  Thoracolumbar ROM testing, after repetitive motion, showed flexion of 60 degrees and combined ROM of 190 degrees.  Painful motion was noted.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, analogously coded 5243 (intervertebral disc syndrome [IVDS]), citing pain-limited flexion to 39 degrees.  The VA rated the back condition 20%, coded 5243, based on the C&P examination, citing forward flexion greater than 30 degrees but not greater than 60 degrees.  The panel agreed that a 20% rating, but no higher, was justified for limitation of flexion (greater than 30 degrees but not greater than 60 degrees), as reported on the PT and C&P examinations proximate to separation.  There was no documentation of IVDS with incapacitating episodes which would provide for a higher rating under that 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 5243.  

BOARD FINDINGS:  In the matter of the back condition, the panel recommends a disability rating of 20%, coded 5243 IAW VASRD §4.71a.  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	
Chronic Low Back Pain	5299-5243	20%	

The following documentary evidence was considered:  

Exhibit A.  DD Form 294, dated 20170422, w/atchs  
Exhibit B.  Service Treatment Record  
Exhibit C.  Department of Veterans Affairs Record  

AR20190007254, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX

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