RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03718
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20061021

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Indirect Fire Infantryman, medically separated for “low back pain” with a disability rating of 10%.  

CI CONTENTION:  The CI made no specific contention.  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 - 20060613	VARD - 20070711	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Low Back Pain	5299-5237	10%	Intervertebral Disc Syndrome	5243	20%	20070111	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40% 	

ANALYSIS SUMMARY:  

Low Back Pain (LBP).  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s back condition began in October 2001 after an armored vehicle hatch door struck the back of his head, neck, and upper back.  Radiographic imaging performed in February 2004 revealed a centrally protruded lumbosacral disc.  At the time of the family practice clinic appointment on 13 December 2004, 22 months prior to separation, the CI complained of a 6-month history of LBP, treated with temporary profiles and epidurals.  His physical examination (PE) revealed tenderness and full range of motion (ROM) of the thoracolumbar spine.  At a physical therapy (PT) appointment on 15 July 2005, 15 months prior to separation, the CI reported back pain.  His PE again revealed tenderness and full ROM of the lower spine.  There was normal curvature of the spine, normal gait, and no muscle spasms reported.

During the 3 February 2006 orthopedic MEB NARSUM examination, 9 months prior to separation, the CI’s PE revealed full ROM of the thoracolumbar spine as well as tenderness.  The CI’s gait and spinal contour were normal.  There were no spinal muscle spasms reported.  During the 10 April 2006 MEB addendum examination, 6 months prior to separation, the examiner reported spinal flexion to 85 degrees (normal 90) and a combined ROM of 235 degrees (normal 240).  

At the 11 January 2007 VA Compensation and Pension (C&P) examination, 3 months after separation, the CI reported constant LBP that traveled to the right leg and foot.  His PE noted a normal gait and posture.  There was no evidence of radiating pain on movement and muscle spasms were absent.  Local tenderness was present.  ROM measurements revealed forward flexion to 60 degrees and a combined ROM of 110 degrees.  However, the examiner noted that the measurements were taken where pain started; there were no measurements recorded indicating how far the CI could move after pain occurred.  The examiner reported signs of intervertebral disc syndrome of sensory deficit of the right leg and right foot with decreased reflexes.  X-ray studies revealed degenerative changes of the lumbar spine.  

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 paraspinal tenderness.  The VA rated the back condition 20%, coded 5243 (intervertebral disc syndrome), citing limitation of motion of the lower back with no incapacitating episodes.  In assigning probative value to these somewhat conflicting ROM examinations, the panel noted that the MEB measurements were consistent with other proximate (pre-separation) examinations by family practice, PT, and orthopedics.  At the post‐separation C&P examination the CI reported no interim history of further injury, surgery, or other aggravation of the back condition.  While ROM limitations may have progressed over time, there was no evidence in the record from which to conclude that the severity at or near separation approached that portrayed by the C&P ROM measurements.  Panel members agreed that the MEB addendum examination was more consistent with outpatient notes and more reflective of the anticipated severity based on the clinical pathology.  The panel therefore relied more heavily on the MEB addendum ROM measurements for rating purposes.  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) and combined ROM (greater than 120 degrees but not greater than 235 degrees) as reported on the MEB NARSUM addendum 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.  After due deliberation, considering all of 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 low back condition.   

BOARD FINDINGS:  In the matter of the low 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:

Exhibit A.  DD Form 294, dated 20170429, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180006241, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

	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.

Sincerely,					      
Enclosure