RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXX	CASE: PD-2017-03128
BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20050507

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, AH-64 Attack Helicopter Repairer, medically separated for “chronic back pain” with a disability rating of 0%.

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 - 20050124	VARD - 20060727	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Back Pain	5237	0%	L3-L4 Bulging Disc	5242	10%	20060509	
COMBINED RATING: 0%	COMBINED RATING OF ALL VA CONDITIONS: 30%	

ANALYSIS SUMMARY:

Chronic Back Pain. According to the service treatment record and MEB narrative summary (NARSUM), the CI’s back pain began in February 2002 after heavy lifting. Radiographic studies showed a bulging intervertebral disc at L3-4. During the 20 June 2004 MEB examination (recorded on DD Forms 2807-1 and 2808), 11 months prior to separation, physical examination revealed no gross deformity of the spine and an absence of tenderness. There was positive straight leg raise (SLR) testing bilaterally. At the 29 September 2004 physical therapy (PT) range of motion (ROM) study showed active flexion of 70 degrees (normal 90) and combined ROM of 220 degrees (normal 240), limited by pain. The 23 November 2004 MEB NARSUM examination, 5 months prior to separation, noted complaints of low 3-4/10 back pain exacerbated with

bending, lifting or prolonged standing. Physical examination referred to the DD Form 2808 and PT ROM examinations above.

At the 9 May 2005 VA Compensation and Pension (C&P) examination, 2 days after separation, the CI reported 6-7/10 low back pain with flares two to three times per week at 8-9/10, that impaired functionality to the extent that he could only walk up to one-half mile and drive up to 90 minutes. Physical examination showed normal gait, posture and spinal curvature. The ROM study showed flexion of 70 degrees and combined ROM of 210 degrees. Painful motion, tenderness and spasm were absent and there was no additional loss following repetition.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the back condition at 0%, coded 5237 (lumbosacral strain), citing combined passive ROM of 260 degrees. The VA rated the back condition at 10%, coded 5242 (degenerative arthritis of the spine), based on the C&P examination, citing flexion of 70 degrees. 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) as reported on the PT and VA examinations. The panel noted the 260 degrees of passive combined ROM noted by the PEB violated the VASRD General Spine Formula rules which require active measurements instead of passive measurements. Also, ROMs higher than the listed normal must be truncated to the normal in each plane of motion. Therefore, the PT combined ROM, after truncating to the maximum normal ROM, was 220 degrees instead of the PEB-cited 260 degrees. 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 the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the back condition coded 5237.

BOARD FINDINGS: In the matter of the back condition, the panel recommends a disability rating of 10%, coded 5237 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 Back Pain	5237	10%	

The following documentary evidence was considered:

PD-2017-03128

[AR NUMBER], XXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXX

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. 

					      
Enclosure

PD-2017-03128