RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03863
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060717

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a Reserve E6, Automated Logistical Specialist, medically separated for “chronic low back pain” with a disability rating of 0%.  

CI CONTENTION:  No specific contention was made.  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 - 20060515	VARD - 20070227	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5243	0%	Degenerative Disc Disease	5243	10%	20061207	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10% 	

ANALYSIS SUMMARY:  

Chronic Low Back Pain (LBP).  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s back condition began in February 1994 after a motor vehicle accident on his way to weekend drill duty.  He was issued a permanent profile and returned to duty.  An MRI on 3 November 2004 showed nerve impingement at L4-5 from a herniated disc and degenerative disc disease at L5-S1.  The CI was seen by numerous medical specialists from 2004 thru 2006.  He received partial relief from injections and physical therapy, but did not have complete resolution.  Surgical intervention was declined.  

In pain management on 23 August 2005, the CI reported pain going down his left leg.  He was noted to have normal range of motion (ROM) of the thoracic spine and normal flexion and extension of the lumbar spine.  The reflexes and gait were also normal.  Three weeks later in physical therapy, the ROM showed flexion, extension and lateral bending to be 25% of normal and rotation 100%.  All motion was painful.  

At orthopedics on 4 October 2005, the ROM of the thoracic spine was normal, but the lumbar spine showed reduced flexion and extension.  Formal strength testing on 14 November 2005 by orthopedics was normal.  A functional capacity evaluation on 8 December 2005 showed decreased strength, but the validity of the test was reduced due to poor effort.  The examiner also noted the ROM was near normal when the CI was distracted.  Three of five signs of non-organic pain were present and five of eight signs of inappropriate illness behavior were present consistent with symptom magnification.  Electrodiagnostic testing on 4 January 2006 was consistent with possible lumbar root involvement at L4-5.  At the 20 March 2006 neurology appointment, approximately 4 months prior to separation, the CI reported low back pain.  The examiner noted limited motion in the lower back.  Strength was preserved and gait steady, but mildly antalgic due to pain.  Spasm was noted.  The 4 May 2006 MEB NARSUM examination, 2 months prior to separation, showed thoracolumbar ROM measurements with flexion of 35 degrees (normal 90) and combined ROM (after rounding) of 75 degrees (normal 240), all limited by pain.  Eight of eight signs of non-organic pain were present.  

At the 7 December 2006 VA Compensation and Pension (C&P) examination, 5 months after separation, the CI reported ongoing LBP.  Physical examination showed no localized tenderness, muscle spasm or guarding severe enough to cause an abnormal gait or spinal contour.  Hip strength was reduced, but the motor evaluation of the lower leg was normal.  Provocative testing for nerve root irritation was negative.  Physical examination showed thoracolumbar lumbar ROM measurements with flexion of 70 degrees and combined ROM of 210 degrees, with pain.  

The 1 May 2007 pain management appointment, approximately 10 months after separation, noted LBP.  Physical examination showed normal flexion when sitting, but reduced to 30 degrees while standing.  Strength testing was unreliable due to inconsistency between the formal testing and observed function (while not being formally measured).  Signs of non-organic pain were abnormal with 5/5 signs present.  He was thought to have discogenic pain with a strong non-organic component.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 0%, coded 5243 (intervertebral disc syndrome), citing no motor neurologic deficit.  The PEB also noted the presence of spinal stenosis which was properly subsumed under the overall back impairment.  The VA rated the back condition 10%, also coded 5243 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 ROM of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees.  The panel noted significant variation in the ROM measurements, which were complicated by multiple examiners finding symptom exaggeration—including the NARSUM measurements.  The panel assigned higher probative value to the VA C&P examination which did not have these comments and was almost equally proximate to separation.  The limitation of thoracolumbar spine motion on this examination supported a 10% rating IAW the VASRD.  A 10% rating was also supported by the presence of painful motion noted on multiple examinations IAW VASRD §4.59, but this provided no rating advantage to the CI.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the back condition, coded 5243.

BOARD FINDINGS:  In the matter of the back condition, the panel recommends a disability rating of 10%, 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	10%	

 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.