RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03222
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20050416

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a National Guard E6, AH-1 Attack Helicopter Repairer, medically separated for “chronic back pain” with a disability rating of 0%.

CI CONTENTION:  Review all conditions.  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 - 20050322	VARD - 20050803	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Back Pain	5241	0%	Lumbar Spine Degenerative Disc Disease	5242	20%	20050627	
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 underwent L4-5 decompression laminectomy in August 2001, microdiskectomy in December 2002, and lumbar interbody fusion in April 2004.  A lumbosacral spine MRI in April 2004 showed L4 degenerative disc disease.  At the 15 October 2004 MEB orthopedic examination, 6 months prior to separation, the CI reported low back pain and intermittent left lower extremity pain.  Physical examination showed a mild antalgic gait, but the CI could heel-to-toe walk.  Range of motion (ROM) testing showed flexion of approximately 45 degrees (normal 90) with pain.  Posture, spinal tenderness and muscle spasms were not addressed.  

The 31 January 2005 MEB examination (recorded on DD Forms 2807-1 and 2808), 3 months prior to separation, revealed no spinal muscle spasms, but “marked” back limitation of motion (not quantified) due to pain.  During the 4 February 2005 MEB NARSUM examination, 2 months prior to separation, the CI reported back movement limited by pain.  Physical examination showed a mild antalgic gait, “marked” back limitation due to pain.  Posture and spinal tenderness were not addressed.  The thoracolumbar ROM evaluation by physical therapy (PT) on 9 February 2004 showed, after repetition, flexion of 80 degrees and combined ROM of 170 degrees (normal 240) with painful motion.  

At the 27 June 2005 VA Compensation and Pension (C&P) examination, 2 month after separation, the CI reported low back pain that occasionally radiated to the right leg.  Physical examination revealed tenderness, but gait and posture were normal, and there was no spinal muscle spasm.  Lumbosacral spine flexion was 55 degrees and combined ROM was 205 degrees with painful motion.  There was no ROM loss following repetition.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 0%, coded 5241 (spinal fusion), citing pain limited ROM without spasm or tenderness.  The VA rated the back condition 20%, coded 5242 (degenerative arthritis of the spine), based on the C&P examination, citing limitation of flexion.  Panel members considered the somewhat disparate ROM examinations and agreed the MEB PT ROM examination represented the only VASRD compliant ROM examination and, therefore, held the most probative value. The orthopedic examination was conducted only 6 months after surgery, and likely represented post-surgical limitations.  It was also an approximated flexion measurement and not the goniometric measurement required by the VASRD.  The post-separation C&P ROM examination recorded “lumbosacral” ROM and not the VASRD required “thoracolumbar” ROM, and the 55 degrees of flexion was close to the normal measurement of 60 degrees for lumbar flexion.  Therefore, 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) and/or limitation of combined ROM (greater than 120 degrees but not greater than 235 degrees), as reported on the MEB PT ROM 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 recommends a disability rating of 10% for the back condition, coded 5241.

BOARD FINDINGS:  In the matter of the back condition, the panel recommends a disability rating of 10%, coded 5241 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	5241	10%	

The following documentary evidence was considered:

AR20190008517, XXXXXXXXXXXXXXXXXX 

XXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX

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. 

	A copy of this decision has also been provided to the Department of Veterans Affairs.

Enclosure