RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXX  	CASE:  PD-2017-03021
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090407

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6, Infantryman, medically separated for “chronic back pain” with a disability rating of 20%.  

CI CONTENTION:  He still suffers daily back pain.  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 - 20090204	VARD - 20090610	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Back Pain	5299-5237	20%	Disk Protrusion. L4-5, Lumbar Spine	5243	20%	STR	
COMBINED RATING:  20%	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 began with gradual onset in April 2006.  The pain worsened during deployment in 2007 after the vehicle he was riding in sustained a heavy impact.  The CI reported low back pain (LBP) with pain radiating down the right lower extremity.  Lumbar spine MRI performed on 4 June 2008 showed a broad-based disc bulge at L4-L5 without significant central spinal canal stenosis or neuroforaminal (area through which the spinal nerves exit) narrowing, but with possible contact of the L5 nerve root.  At a pain and spine medicine examination on 4 August 2008, the CI reported LBP that radiated down the right thigh.  Physical examination showed “minimal” restriction of range of motion (ROM) with tenderness of the lumbar paraspinal muscles and over the right sacroiliac joint.  Tests for sacroiliac pain were positive.  Straight leg raise testing to elicit radicular symptoms was negative.  Strength, sensation, and reflexes were normal.  The CI was offered injections of the right sacroiliac joint and/or L5 facet joint and after consideration declined treatment.  

The 9 January 2009 MEB NARSUM examination, 3 months prior to separation, noted complaints of constant LBP.  Physical examination showed no evidence of leg muscle atrophy.  The CI walked with a somewhat protective gait and straight leg raising at 60 degrees caused mild pulling in the right lower back.  Thoracolumbar ROM measurements were only approximated and the examiner indicated flexion of “approximately 45” degrees (normal 90) and extension of “approximately 5” degrees (normal 30) with painful motion associated with all movement.  Physical therapy (PT) measured thoracolumbar ROM for the MEB on 3 days later and after three repetitions active flexion was 60 degrees  and combined ROM was 210 degrees (normal 240), with painful flexion noted.  There was no VA examination proximate to separation in evidence.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 20%, analogously coded 5299-5237 (lumbosacral strain), citing 45 degrees forward flexion.  The VA also rated the back condition 20%, coded 5243 (intervertebral disc syndrome [IVDS]), based on the STR, citing average forward flexion of 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 MEB PT ROM and MEB NARSUM examinations.  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 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:

PD-2017-03021

[AR NUMBER], XXXXXXXXXXXXXXX 

Dear XXXXXXXXXX

	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.

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Enclosure

PD-2017-03021