RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03313
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20051230

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Motor Transport Operator, medically separated for “low back pain” with a disability rating of 0%.   

CI CONTENTION:  The condition continues to worsen.  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 - 20050919	VARD – 20060502	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Radiating Low Back Pain	5243	0%	L4-L5 Disc Disease 	5003-5243	10%	20060227	
	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Chronic Radiating Low Back Pain.  According to service treatment record and the MEB narrative summary (NARSUM), the CI had a 5-year history of progressive lower back pain which radiated down his right leg.  The condition progressed to a point that it limited his ability to perform his duties.  Although the CI reported no trauma or injury, he did a lot of driving over rough terrain which increased his vibration exposure.  The MRI revealed a small herniation at L4-5 and degenerative disk changes at L5-S1. 

During the 15 August 2005 MEB examination (recorded on DD Forms 2807-1 and 2808) 4 months prior to separation, the range of motion evaluation, after truncation, showed flexion of 90 degrees (normal) with pain, extension of 30 degrees (normal), right and left lateral flexion of 30 degrees each (normal).  

The 1 September 2005 MEB NARSUM examination, 4 months prior to separation, showed no significant scoliosis, step off or abnormalities on palpation of the lumbar spine.  The ROM evaluation showed forward flexion of 90 degrees and combined ROM of 190 degrees (normal 240).  Motor strength and reflexes were normal and no clonus was present.  Straight leg raise on the right caused significant pain.  The examination did not address gait, tenderness or spasm.

At the 27 February 2006 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported the inability to run, play sports or stand, sit or walk for long periods, but the back pain was not severe enough to interfere with his work as a truck driver.  He believed he normally had full ROM and could probably bend over fully but staying bent forward or flexed for even a minute or two led to severe pain.  Mild flare-ups, for a day or two, occurred with activities but lasted only a few hours if he took Naprosyn or Ibuprofen (anti-inflammatory medication).  The flares often were accompanied by continued restriction of flexion.  Physical examination showed no tenderness or muscle spasm, but he had a slight bent forward posture and a gait typified by the posture.  The major abnormality was his careful, cautious steps due to foot pain from his flat feet.  Flexion was 90 degrees, with pain, and combined ROM was 220 degrees.  There was pain with extension and left lateral flexion.  Flexion was limited to 75 degrees and extension to 10 degrees after repetition.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 0%, coded 5243 (intervertebral disc syndrome), citing normal posture, no tenderness, full motion and no evidence of radiculopathy.  The VA rated the back condition 10%, coded 5003-5243 (arthritis-intervertebral disc syndrome) based on the C&P examination 2 months after separation, citing painful motion with combined motion limited to 220 degrees, reduced to 200 degrees with repetition.  The panel agreed that a 10% rating, but no higher, was justified for limitation of combined ROM (greater than 120 degrees but not greater than 235 degrees), as reported on the MEB NARSUM and VA C&P examinations proximate to separation.  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.  Gait changes were attributed to the CI’s foot pain.    After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the back condition, coded 5003-5243.  

BOARD FINDINGS:  In the matter of the back condition, the panel recommends a disability rating of 10%, coded 5003-5243 IAW VASRD §4.71a.  There are no other conditions within the panel’s scope of review for consideration.  

The panel recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Radiating Low Back Pain	5003-5243	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170508, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR20180008820, 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.

Sincerely,					      
Enclosure