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Dear XXXXXXXXXX

	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.

RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX.	CASE:  PD-2017-03604
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080804

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 10%. 

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 - 20080516	VARD - 20081003	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5299-5237	10%	Lumbar Strain	5237-5010	10%	20080918	
Chronic Leg Pain	Not Unfitting	No VA Placement	
Anxiety Disorder	Not Unfitting	Generalized Anxiety Disorder	9400	50%	20080918	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s back condition began insidiously in October 2004.  A lumbar spine CT scan showed a small disc protrusion at L5-S1 contacting the right S1 root.  An MRI of the lumbar spine revealed L5-S1 retrolisthesis and degenerative disc disease with mass effect on the neural foramen effacing the L5 nerve root.  

At the 11 February 2008 MEB NARSUM examination, 6 months prior to separation, the CI complained of chronic low back pain that radiated to the hips and down the legs to the toes.  She also complained of intermittent leg tingling.  Although she was able to work 12-hour days, prolonged sitting made her back pain worse and she was unable to lift heavy boxes.  The examiner noted the CI’s medical record showed the CI on quarters for three days for back pain.  Physical examination showed a normal gait without tenderness, guarding or spasm.  There was no loss of lumbar lordosis.  The range of motion (ROM) evaluation showed decreased flexion, but the examiner did not specify the amount of decrease.  Lateral flexion to the left and right as well as extension were normal.  Motor strength, reflexes and sensation were normal.  The 25 February 2008 physical therapy ROM study, after repetition, showed flexion of 60 degrees (normal 90) and combined thoracolumbar ROM of 205 degrees (normal 240).  

During the 26 February 2008 MEB examination (recorded on DD Forms 2807-1 and 2808), 5 months prior to separation, the CI reported pain, numbness and tingling in the bilateral legs affecting her ability to stand or walk for prolonged periods of time.  Physical examination showed tenderness and low back pain with flexion.  The 23 April 2008 primary care clinic (PCC) examination, 3 months prior to separation, noted complaints of low back pain that flared with excessive walking or prolonged standing.  The ROM evaluation showed 65 degrees of flexion with normal extension, lateral flexion and rotation.  There was pain in almost all planes of motion.  

At the 18 September 2008 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported pain that radiated down both legs, but denied incapacitating episodes.  Physical examination showed a normal gait without spasm, but there was tenderness.  The ROM evaluation, after repetition, showed flexion of 75 degrees and combined ROM of 215 degrees with pain in all planes of motion.  Motor strength, sensation and reflexes were normal and straight leg raise testing was negative.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, analogously coded 5237 (lumbosacral strain), citing 65 degrees of forward flexion.  The VA also rated the back condition 10%, dual coded 5237-5010 (lumbosacral strain and traumatic arthritis), based on the C&P examination, citing limitation of motion of a major joint due to pain.  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 PCC and C&P examinations most 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.  There was no evidence of intervertebral disc syndrome 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 concluded there was insufficient cause to recommend a change in the PEB adjudication for the back condition.  

Contended PEB Conditions:  Chronic Leg Pain and Anxiety Disorder.  The panel’s main charge is to assess the fairness of the PEB determinations that the contended conditions were not unfitting.  Neither of the conditions were profiled or implicated in the commander’s statement.  There was no performance-based evidence from the record that either of the conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions, so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the back condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended leg pain and anxiety disorder, the panel recommends no change from the PEB determinations as not unfitting.  
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.