RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03820
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060118

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

CI CONTENTION:  The CI’s condition continues to worsen.  The complete submission is 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 – 20051208	VARD – 20060629 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5237	0%	Degenerative Disc Disease	5243	10%	20060612	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10% 	

ANALYSIS SUMMARY:  

Low Back Pain (LBP).  According to service treatment record and the MEB narrative summary (NARSUM), the CI’s LBP began in 2002 without any specific injury or trauma.  A 22 December 2004 scoliosis survey was interpreted as showing a mild S-curvature of the thoracolumbar spine, and a transitional lumbosacral vertebral body with focal angulation and vertebral body height loss consistent with compression fracture was noted.  A February 2005 MRI demonstrated a "congenital anomaly of the S1 vertebral segment, which had a transitional appearance.”  There was no evidence of significant spinal canal stenosis or neural foraminal narrowing.  Lumbosacral X-rays showed no evidence of an osseous lesion or acute fracture.  

During the 29 August 2005 MEB examination (recorded on DD Forms 2807-1 and 2808), 5 months prior to separation, physical examination showed slow painful active range of motion (ROM) of the spine.  The 23 September 2005 MEB NARSUM examination, 4 months prior to separation, included reports of constant lumbar pain rated as a 4/10, which occasionally rose to an 8 or 9 depending on his exercise level.  If he sat for a long time it was difficult for him to get up.  His back was aggravated most by bending, twisting, straining, or lifting.  He had no bowel or bladder problems, leg numbness, tingling, or pain.  Physical examination showed tenderness of the lumbar muscles, and the lower lumbar spine was essentially rigid on extension and lateral bending.  He was able to forward flex to about 45 degrees (normal 90).  Thoracolumbar ROM measurements performed by physical therapy (PT) on that day showed flexion of 110 degrees and a combined ROM of 240 degrees (normal) after repetition, all with a complaint of pain.  All measurements were taken with a goniometer. A 26 September 2005 orthopedic evaluation, 4 months prior to separation, noted complaints of pain with bending and twisting and some numbness in his left leg on one occasion.  Thoracolumbar ROM measurements showed flexion of 70 to 80 degrees with pain.  The examiner concluded with a diagnosis of chronic back pain, non-radicular scoliosis, and bulging disk at L4-5.  There was no surgical indication.  

At the 12 June 2006 VA Compensation and Pension (C&P) examination, 5 months after separation, the CI reported constant low back pain without radiation (4/10) with flare-ups (7/10) every other day lasting approximately 1/2 hour.  Physical examination showed tenderness, and straight leg raising test equivocally positive at 5 degrees bilaterally.  Thoracolumbar ROM measurements showed flexion of 90 degrees and combined ROM of 230 degrees after repetition.  No mention was made of painful motion.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the LBP pain condition 0%, coded 5237 (lumbar spine strain), citing full ROM, without radiculopathy but with tenderness to paraspinal muscle palpation.  The panel noted that the PEB Form 199 showed that the PEB rated the CI at 10% in their description of the disability, yet on the rating column rated him at 0%.  This was clearly an administrative error.  The panel has used the rating in the final column as our base reference.  The VA rated the degenerative disc disease condition 10%, coded 5243 (intervertebral disc syndrome), based on the C&P examination, citing forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or, combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees.  

The panel noted that on the NARSUM examination the CI had flexion of 45 degrees.  However, three days later he had 70-80 degrees, and 90 degrees at the C&P examinations.  The panel concluded that the NARSUM examination was not in agreement with the later measurements and not indicative of his overall condition.  There was a limitation of thoracolumbar spine motion to support a 10% rating under the General Rating Formula for Diseases and Injuries of the Spine (5237) based on the orthopedic 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 intervertebral disc syndrome which resulted in incapacitating episodes requiring physician-prescribed bed rest to warrant consideration of rating under that alternate VASRD formula.  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 low back condition, coded 5237.  

BOARD FINDINGS:  In the matter of the chronic LBP condition, the panel recommends a disability rating of 10%, coded 5237 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 the date of medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Low Back Pain	5237	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170413, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180006662, 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