RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXX	CASE:  PD-2017-03275
BRANCH OF SERVICE:  Army 		SEPARATION DATE:  20050904

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

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 - 20050729	VARD - 20051104	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain, without Neurologic Deficit	5299-5237	10%	Mechanical Low Back Pain	5237	20%	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s low back condition began in October 2002 while changing a military vehicle tire during Operation Iraqi Freedom.  MRI from 21 November 2003 revealed very mild posterior disc protrusions at multiple levels.  Findings suggested small associated annular tears which could cause significant back pain.  There was no significant herniated disc, neural foraminal narrowing or spinal canal stenosis at any level.  He was referred back to orthopedics in August 2004 for surgical consideration.  A new MRI and an EMG were ordered and read as normal.  No surgical recommendation was made.  He was seen again by the orthopedic physician in November 2004 who diagnosed the CI with lumbago and returned to duty without a profile.  

The 14 February 2005 MEB NARSUM examination, 7 months prior to separation, noted complaints of low back pain.  Physical examination showed back tenderness with decreased range of motion (ROM).  Straight leg raise (SLR) testing was positive bilaterally on the lower extremities.  Waddell’s signs were negative and the CI could heel-toe walk without complications.  .  He had no loss of sensation in the upper and lower extremities bilaterally and strength was 5/5, with deep tendon reflexes 2+ bilaterally.  There was no evidence of muscular atrophy for the upper and lower extremities, back, or thorax.  

During the 30 March 2005 MEB examination (recorded on DD Forms 2807-1 and 2808), approximately 5 months prior to separation, the CI reported recurrent back pain. Physical examination revealed tenderness.  Strength was 5/5 and sensation was intact. ROM was decreased.  No measurements were recorded.  At the time of the physical therapy clinic appointment on 21 June 2005, 2 months prior to separation, the CI reported 3/10 low back pain.  On examination “lumbar” spine ROM after repetition showed flexion of 60 degrees (normal) and combined ROM of 195 degrees.  Painful motion was 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 low back condition 10%, analogously coded 5237 (lumbosacral strain), citing range of motion limited by pain.  The VA rated the low back condition 20%, also coded 5237, based on the STR, citing limitation of motion of flexion to 60 degrees.  Although, there was insufficient limitation of motion to support a 10% rating, the panel agreed a 10% rating was justified for the presence of painful motion.  The panel noted the only examination that reported ROM with numerical measurements, utilized “lumbar” ROM values, which are not IAW VASRD 4.71a.  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 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-2017-03275

AR20190010026, XXXXXXXXXXXXXX 

Dear XXXXXXXXXXXXX

	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.

Enclosure

PD-2017-03275