RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03432
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050518

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

CI CONTENTION:  He has been in constant pain since 2003/2004 and questions how back issues are evaluated.  His condition continues to worsen and negatively impact daily activities.  He should have been given the option to medically retire.  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 - 20050428	VARD - 20050923	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5237	10%	Degenerative Disc Disease, Lumbar Spine	5243	0%	20050827	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s chronic low back condition began in early 2003 when he was exiting a HUMVEE vehicle and felt his back “give out.”  There was an onset of localized pain and decreased mobility with symptoms lasting 7-10 days which resolved spontaneously.  Similar episodes occurred throughout his 12 month deployment which ended in February 2004.  On 29 September 2004 he fell approximately 6-7 feet from an obstacle course and landed on his back, causing severe pain, but he was able to complete the course in an unusual and hunched over position. An MRI dated 6 October 2004 showed broad based disc bulges and osteophyte complexes present at L3-L4 and L4-L5 which impressed on the anterior thecal sac, along with bilateral neural foraminal (the site where nerves pass through the vertebral column) narrowing, the left more than the right, at L4-L5.  The CI was referred to physical therapy and had several visits without resolution of his pain.  A neurosurgical consultant on 23 December 2004 determined he was not a candidate for surgical intervention.  Physical therapy range of motion (ROM) measurements performed on 18 March 2005, 2 months prior to separation, showed flexion of 55 degrees (normal 90) and a combined ROM of 175 degrees (normal 240).  

The 22 March 2005 MEB NARSUM examination, 2 months prior to separation, noted complaints of daily pain in his lower back, described as constant and dull and occurring regardless of activity or position.  Pain intensity was rated at 4-5/10 with more intense pain at 7-8/10 occurring with increased physical activity.  Significant pain was reported when the CI tried to run.  Physical examination showed no visual abnormalities, no spasm, and no focal trigger-points.  Straight leg raising (to determine nerve root irritation) was negative and motor strength of the lower extremities was normal.  The examiner noted ROM was decreased secondary to discomfort, but no ROM measurements were taken.  

At the 27 August 2005 VA Compensation and Pension (C&P) examination, 3 months after separation, the CI reported having a significant amount of low back pain.  Initially, some of the low back pain was reported to radiate into the left testicle region; however, there was no significant radicular pain into the legs.  Repetitive lifting and bending were reported to aggravate the pain.  No incapacitating episodes or bowel/bladder dysfunction was reported.  Physical examination showed a normal-appearing gait.  Toe raise and heel raise were present.  ROM was painless with lumbar flexion at 90 degrees and a combined ROM of 240 degrees.  There was no limitation secondary to weakness, fatigability, incoordination, or flare-ups.    No paraspinal musculature spasms or tenderness was noted.  Neurological examination showed good muscle strength, sensation intact, and deep tendon reflexes 2+ bilaterally.  No assistive devices were used and no incapacitation was reported.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic low back condition 10%, coded 5237 (lumbosacral strain), citing tenderness and some loss of spinal motion due to pain alone.  The VA rated the degenerative disc disease, lumbar spine condition 0%, coded 5243 (intervertebral disc syndrome), based on the C&P examination, citing no evidence of decreased ROM or painful motion.  The panel majority agreed that a 20% rating, but no higher, was justified for limitation of flexion (greater than 30 degrees but not greater than 60 degrees) reported on the physical therapy examination.  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 20% for the chronic low back pain condition, coded 5237.  

BOARD FINDINGS:  In the matter of the chronic low back pain condition, the panel majority recommends a disability rating of 20%, coded 5237 IAW VASRD §4.71a.  The single voter for dissent recommends no change and did not elect to submit a minority opinion.  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	5237	20%	

AR20180015391, 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.