RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03830
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070112

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a Reserve E7, Health Care Specialist, medically separated for “chronic low back pain” with a disability rating of 10%. 

CI CONTENTION:  In addition to the back condition, the CI requested review of an additional condition not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB).  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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the 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 - 20061128	VARD - 20070516	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5299-5243	10%	Degenerative Disc Disease L4-5	5243	20%	20061109	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  80%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s back condition began in June 2004 after heavy lifting.  Lumbar spine X-rays showed loss of the normal lordosis with degenerative changes from L3-S1, CT scan showed disc bulge at L5-S1, touching the adjacent S1 nerve roots, and MRI showed degenerative disc disease and loss of normal lordosis.  Neurosurgery did not recommend surgery.

The 29 August 2006 MEB NARSUM examination, 4 months prior to separation, noted complaints of problems remaining upright for more than 10-20 minutes without having to move about and difficulty lifting more than 30 pounds.  His back pain radiated into the right lower extremity to the thigh and there was intermittent numbness to the right foot.  Physical examination showed tenderness and mild muscle spasm with slight loss of normal lumbar lordosis, but heel-to-toe walk was normal.  Lumbosacral (not thoracolumbar) range of motion (ROM) testing showed flexion of 20 degrees (normal 60), extension of 10 degrees (normal 30).  Thoracolumbar ROM testing showed bilateral rotation and lateral flexion of 30 degrees (normal), with painful motion.

At the 9 November 2006 VA Compensation and Pension (C&P) examination, 2 months before separation, the CI reported symptoms of fatigue, decreased motion, stiffness, weakness, spasm and burning back pain, which radiated into the mid-thigh or sometimes knee.  Physical examination showed a normal gait and spinal contour without spasm, tenderness or weakness, but there was guarding on the right.  Lower extremity motor strength, reflexes and sensation were normal.  The thoracolumbar ROM evaluation, after repetitive use, showed flexion of 45 degrees (normal 90) and combined ROM of 165 degrees (normal 240), with painful motion.  

During the 26 October 2007 C&P examination, 10 months after separation, the CI reported constant daily low back pain with intermittent burning pain, numbness and tingling down the right leg to the toes.  Physical examination showed a normal gait, erect posture and no deformities.  The ROM evaluation showed 40 degrees of flexion and 145 degrees of combined thoracolumbar ROM.  There was pain in all planes of motion, but no additional loss of motion after repetition due to pain, weakness or fatigue.  Motor strength, sensation and reflexes were normal. 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, analogously coded 5299-5243 (intervertebral disc syndrome), citing pain limited ROM and spasm.  The VA rated the back condition 20%, coded 5243, 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 noted that both VA examinations supported a 20% rating for limitation of flexion greater than 30 degrees but not greater than 60 degrees.  The MEB NARSUM examination noted lumbosacral flexion of 20 degrees, but normal isolated lumbar ROM is approximately 60 degrees.  There is often imprecise documentation of whether ROM is lumbar or thoracolumbar ROM and how the examiner refers to it is not always meaningful – back ROM, ROM, lumbar ROM etc.  However, in this case the MEB examiner referred to lumbosacral flexion and extension, but thoracolumbar lateral flexion and rotation.  Therefore, the panel concluded that this was lumbar ROM of 20 degrees, which equates to approximately 50 degrees of thoracolumbar flexion, and this is consistent with the two VA examinations.  In any case, the VA examination 2 months prior to separation was the most proximate examination to separation, and the panel agreed it held more probative value for rating because it was more proximate to separation and ROM measurements were of the thoracolumbar spine.  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 of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 20% for the back condition, coded 5243.  

BOARD FINDINGS:  In the matter of the back condition, the panel recommends a disability rating of 20%, coded 5243 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	5243	20%	

AR20180015548, 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.