RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03175
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20060109

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Infantryman, medically separated for “low back pain” with a disability rating of 10%.  

CI CONTENTION:  Review requested of low back pain and additional conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB).  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 - 20051025	VARD - 20060328	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5237	10%	Disc Protrusion with Possible Punctate Annular Tear L4-5 with Paralumbar Muscle Spasm Diffuse Narrowing of Thecal Sac 	5243	10%	20051221	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s low back pain began in January 2004 after falling.  He was treated 5 times with physical therapy, stretching exercises, and electric stimulation, which was mildly beneficial.  He was then treated with temporary profiles and anti-inflammatory medications.  An MRI in January 2005 revealed a tiny midline disc protrusion with possible punctate annular tear at L4 and L5, and mild to moderate crowding of the thecal sac at L4-L5.  There was also an underlying diffuse narrowing of the thecal sac from L2 to L5, which was most likely congenital.  He was referred to orthopedics and pain management where he was evaluated and treated with steroid injections, which were not beneficial, and placed on a permanent profile.  

During the 1 September 2005 MEB examination (recorded on DD Forms 2807-1 and 2808), 4 months before separation, the examiner noted lumbar spine tenderness and painful range of motion (ROM) with flexion to 70 degrees (normal 90).  Straight leg raise (SLR) tests showed pain at 30 degrees bilaterally.  The 12 September 2005 MEB NARSUM examination noted complaints of low back pain, and physical examination showed midline lumber spine tenderness but no paraspinal muscle tenderness.   He was able to heel and toe walk, and ROM was decreased, secondary to pain (not quantified).  Lower extremity strength and sensation was intact.  

At the 21 December 2005 VA Compensation and Pension (C&P) examination, 1 month before separation, the CI reported chronic low back pain.  Physical examination showed normal gait and station, and no use of assistive aids for ambulation.  Measured ROM revealed painful flexion to 70 degrees with a combined ROM of 160 degrees (normal 240) after repetition;   SLR testing showed pain at 90 degrees bilaterally.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back pain 10%, coded 5237 (lumbosacral strain), citing pain limiting ROM and tenderness.  The VA also rated the low back pain 10%, but coded 5243 (intervertebral disc syndrome (IVDS)), based on the C&P examination, citing flexion to 70 degrees and total combined ROM 160 degrees.  Panel members agreed there was no evidence to support a rating higher than that adjudicated by the PEB.  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 MEB NARSUM and VA examinations.  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 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 low back pain.  

BOARD FINDINGS:  In the matter of the chronic low back pain 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:

AR20190008710, 

Dear XXXXXXXXXXXXXXXXX:

	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