RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX 	CASE:  PD-2017-03192
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080709

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Tracked Vehicle Mechanic, medically separated for “chronic low back pain” with a disability rating of 10%.  

CI CONTENTION:  Condition continues to worsen and negatively impact daily activities.  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 - 20080318	VARD - 20080918	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5299-5237	10%	Lumbar DDD and Bulging Discs	5243	10%	20080605	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS: 10%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain (LBP).  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s chronic low back condition began gradually in August 2005 while deployed.  No trauma or injury was reported.  In January 2006, the CI was issued a temporary profile and Motrin (anti-inflammatory medication).  X-rays of the lumbar spine on 6 March 2006 revealed a mild early degenerative disc disease (DDD) at the lumbosacral junction indicated only by mild disc space loss.  An MRI of his lumbar spine on 13 September 2006 was notable for transitional vertebra with lumbarization of the first sacral segment, mild narrowing of the L5-S1 disk with a small right paracentral disk bulge causing mild to moderate right central canal and right lateral recess stenosis, and very broad bulges at L2-L3, L3-L4, and L4-L5 without significant stenosis.  Despite a course of epidural steroids and chiropractic care, the CI only had temporary relief.  He was determined to not be a surgical candidate.  

The 3 December 2007 MEB NARSUM examination, 7 months prior to separation, noted complaints of throbbing and achy LBP on a scale of 8/10, with intermittent shooting pain, numbness, and tingling but no bladder or bowel disturbances.  Physical examination showed range of motion (ROM) flexion of 90 degrees (normal) and combined ROM of 240 (normal).  

At the 6 June 2008 VA Compensation and Pension (C&P) examination, 1 month before separation, the CI reported pain intensity at 8/10 with flares increasing the pain to 10/10.  Radiating pain down the back of the thighs was reported, but no pins, needles, tingling, numbness, weakness, or bowel/bladder incontinence.  Physical examination showed normal spinal curvature and gait.  ROM showed flexion to 70 degrees and combined ROM of 220 degrees with painful motion.   There was no tenderness over the spinous processes, no spasm, tenderness or trigger points.  Neurological and deep tendon reflexes were intact.  Straight leg raising could be done to 80 degrees without complaint of pain in both the supine position and sitting position.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back condition 10%, analogously coded 5237 (lumbosacral strain), citing tenderness.  The VA also rated the low back condition 10%, coded 5243 (intervertebral disc syndrome), based on the C&P examination, citing flexion of 70 degrees.  The panel agreed a 10% rating was justified for the presence of painful motion as reported on the NARSUM and VA examinations.  The panel noted a 10% rating, but no higher, could also be 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  VA examination.  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 concluded there was insufficient cause to recommend a change in the PEB adjudication for the chronic low back condition.  

BOARD FINDINGS:  In the matter of the chronic low back condition and IAW VASRD §4.71, 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 20170412, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR, 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