RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXXX	CASE: PD-2017-03853
BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20080108

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Automated Logistical Specialist, medically separated for “chronic low back pain” with a disability rating of 0%.

CI CONTENTION: “Back issues continue to cause issues.” Review requested of additional conditions 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 - 20071011	VARD - 20080501	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5237	0%	Lumbar Spine DJD	5242	20%	20080225	
COMBINED RATING: 0%	COMBINED RATING OF ALL VA CONDITIONS: 40%	

ANALYSIS SUMMARY:

Chronic Low Back Pain. According to the service treatment record and MEB narrative summary (NARSUM), the CI’s back condition began in March 2003 after a motor vehicle accident. The CI reported lower back pain radiating to the hips. Lumbar spine MRI in June 2007 revealed mild annular bulging at L4-5 without spinal canal or nerve compromise and mild degeneration of the right facet joint at L5-S1. Despite physical therapy (PT), medication and chiropractic treatment, the CI was unable to resume duty in his specialty.

At the PT examination for LBP on 3 August 2007, 5 months prior to separation, the CI reported back pain, rated at 6.5/10 that day and varying from 4/10 to 10/10 over the previous 7 days. The pain was aggravated by running, carrying weight, lifting, pushing, pulling or standing for over 20 minutes.  Physical examination revealed thoracolumbar ROM was flexion of 40 degrees (normal
90) and combined ROM of 100 degrees (normal 240) after repetition with motion limited by pain.

During the 24 August 2007 MEB examination (recorded on DD Forms 2807-1 and 2808), 4 months prior to separation, the CI reported chronic back pain, rated at 8/10 and made worse by strenuous straining, pushing and pulling on the back. Physical examination showed ROM of flexion to 45 degrees and 20-30 degrees right and left rotation and bending. The examiner noted there was no evidence of spasm. The 10 September 2007 MEB NARSUM examination noted complaints of constant pain throughout the day, beginning when he awakened. The pain was exacerbated by standing, walking, bending or twisting. Physical examination showed pain limited flexion at “perhaps” 40 degrees, and combined ROM of 110 degrees. No tenderness or spasm were observed.

At the 25 February 2008 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported intermittent mild back pain described as shooting and throbbing. Physical examination showed normal gait and posture. Thoracolumbar ROM was recorded as flexion to 60 degrees and combined ROM of 210 degrees with no pain on motion, tenderness, spasm and no additional limitation after repetitive movement. Same-day radiographic studies (X-rays of the thoracic spine showed mild degenerative joint disease (DJD) of the mid thoracic spine and lumbar spine X-rays showed mild degenerative changes at T12-L1.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the back condition 0%, coded 5237 (lumbosacral strain), citing “range of motion is limited to 40 degrees by pain alone.” The VA rated the DJD, lumbar spine condition 20%, coded 5242 (degenerative arthritis of the spine), 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 agreed that a 20% rating, but no higher, was justified for limitation of flexion (greater than 30 degrees but not greater than 60 degrees) as reported on all examinations proximate to separation. 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 back condition, coded 5237.

BOARD FINDINGS: In the matter of the chronic low back pain, the panel recommends a disability rating of 20%, coded 5237 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	5237	20%	

PD-2017-03853

AR20190011851, XXXXXXXXXXXXXXXXXXXXXXX 

Dear XXXXXXXXXXXXX

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.

PD-2017-03853