RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02954
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20060629

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Infantryman, medically separated for “chronic low back pain secondary to myofascial pain syndrome of the lumbar paraspinous muscles” with a disability rating of 10%.  

CI CONTENTION:  “Degenerating condition with constant pain, reduced mobility and will require multiple future surgeries.”  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 - 20060512	VARD - 20070809	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain…	5299-5237	10%	Lumbar Stenosis with Disc Bulging at L5-S1	5237	20%	20070316	
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 underwent an L5-S1 discectomy with laminectomy in April 2004.  Initially, he did well and deployed in January 2005.  However, he had a recurrence of back pain he attributed to vibrations in tactical vehicles and wearing body armor.  A lumber MRI in February 2006, and a myelogram (dye test to evaluate the spine) in March 2006, did not demonstrate further surgical indication, and the surgeon opined the back pain was then due to myofascial pain syndrome and scars from the previous surgery.  
The 26 April 2006 MEB NARSUM examination, 2 months prior to separation, noted CI complaints of LBP that prevented running, jumping, sit-ups, push-ups, heavy lifting, and riding in tactical vehicles.  He was also unable to sit or stand for more than 10 to 20 minutes without significant pain.  Physical examination showed forward flexion to 75 degrees (normal 90) and combined range of motion (ROM) of 165 degrees (normal 240).  

At the 16 March 2007 VA Compensation and Pension (C&P) examination, 9 months after separation, the CI reported constant LBP with occasional flare-ups lasting a few minutes and accompanied by a burning sensation radiating down his right leg;  this was exacerbated by sitting for prolonged periods and relieved by slowly moving around.  Physical examination demonstrated normal posture and gait.  Forward flexion was to 55 degrees (normal 90) and combined ROM was 140 degrees (normal 240).  The provider noted tenderness and painful motion, but no spasm or guarding.  

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 flexion to 80 degrees.  The VA rated the low back condition 20%, coded 5237, based on the C&P examination, citing flexion greater than 30 degrees but not greater than 60 degrees.  Panel members agreed that a 10% rating, but no higher, was justified for limitation of flexion (greater than 60 degrees but not greater than 85 degrees) and combined ROM (greater than 120 degrees but not greater than 235 degrees), as reported on the NARSUM examination which was most proximate to separation.  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.  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 LBP condition.  

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, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180008810, 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