RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXX  	CASE:  PD-2017-03363
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20061117

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Health Care Specialist, medically separated for “chronic low back pain” with a disability rating of 0%.  

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 – 20061026 	VARD - 20070706	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5241	0%	Lumbar Degenerative Disc Disease, Status Post Fusion, with Scar	5243	20%	20070614 	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  50% 	

ANALYSIS SUMMARY:  

Chronic Low Back Pain.  According to the service treatment record (STR) and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent a posterior lumbar discectomy and spinal fusion in March of 2006.  Postoperative studies demonstrated fusion of L5-S1 with all hardware components in the appropriate position.  The 29 September 2006 MEB NARSUM examination, 2 months prior to separation, noted complaints of persistent low back and leg pain despite a restrictive profile.  The CI’s physical examination (PE) revealed an antalgic gait.  Thoracolumbar range of motion (ROM) measurements performed by physical therapy (PT) on 4 October 2006 noted forward flexion of 65 degrees (normal 90) and combined ROM of 180 degrees (normal 240) after repetition, and associated with painful motion.  

At the 14 June 2007 VA Compensation and Pension (C&P) examination, 7 months after separation, the CI reported pain in his mid-low back without peripheral extension.  Additionally, he endorsed having many painful flare-ups per day with the frequency of the same dependent upon his activity level.  His PE revealed a normal gait and mild tenderness without muscle spasms of the lower spine.  Thoracolumbar ROM measurements showed forward flexion to 85 degrees (normal 90) and combined ROM of 205 degrees (normal 240), associated with painful motion.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back condition 0%, coded 5241 (spinal fusion), citing flexion limited to 68 degrees by pain, no weakness in the lower extremity or muscle atrophy, sensory intact, no spasm or radiculopathy.  The VA rated the low back condition 20%, coded 5243 (intervertebral disc syndrome [IVDS]), based on the C&P examination, citing forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees.  

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), as reported on the pre-separation NARSUM PT 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 evidence of IVDS which resulted in incapacitating episodes requiring physician-prescribed bed rest to warrant consideration of rating under the alternate VASRD formula for that condition.  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 low back condition, coded 5241.  

BOARD FINDINGS:  In the matter of the low 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 Low Back Pain	5241	10%	

The following documentary evidence was considered:

	

, XXXXXXXXXXXXX 

Dear XXXXXXXXXXXXX

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