RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXX	CASE: PD-2017-03877
BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20091122

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Utility Equipment Repairer, medically separated for “low back pain” with a disability rating of 10%.

CI CONTENTION:  Review all conditions.  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 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 - 20090814	VARD - 20100210	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5237	20%	Lumbar Spine Degenerative Disc Disease	5243	40%	20091222	
COMBINED RATING: 20%	COMBINED RATING OF ALL VA CONDITIONS: 50%	

ANALYSIS SUMMARY:

Chronic Low Back Pain (LBP). According to the service treatment record and MEB narrative summary (NARSUM), the CI’s LBP began in December 2007 after performing a ruck march. The neurosurgeon determined the CI was not a surgical candidate. The 21 July 2009 MEB NARSUM examination, 4 months prior to separation, noted complaints of continued LBP. The physical examination (PE) revealed painful thoracolumbar ROM of forward flexion to 60 degrees (normal
90) and combined ROM of 190 degrees (normal 240). There was no evidence of abnormal spinal curvatures or localized spasms. Electro-diagnostic studies revealed no evidence of radiculopathy.

At the 22 December 2009 VA Compensation and Pension (C&P) examination, 1 month after separation, the CI endorsed continuous LBP with extension into the right lower extremity. He took no medications and was functional in all activities of daily living. The provider recorded that “over the last year of active duty service, the [CI] missed no days of duty due to illness or injury.” The PE revealed a normal gait without abnormal spinal curvatures, but tenderness was present. Lumbar spine ROM testing noted forward flexion to 30 degrees and combined ROM of 170 degrees.  Peripheral sensory and motor activity were intact and normal.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the back condition 20%, analogously coded 5237 (lumbosacral strain), citing forward flexion to 40 degrees. The VA rated the back condition 40%, analogously coded 5243 (intervertebral disc syndrome), based on the C&P examination, citing forward flexion of the thoracolumbar spine of 30 degrees or less.

Panel members noted the ROM values nearest to separation by the VA examiner were significantly worse than those reported by the 4 month pre-separation MEB examiner. There was no record of interim injury or pathology in explanation of the more marked impairment reflected by the VA measurements. While ROM limitations may have progressed over time, there was no evidence in the STR from which to conclude that the severity near separation approached that portrayed by the VA measurements. Panel members agreed that the MEB examination was more consistent with prior outpatient notes and thus more reflective of the anticipated severity based on the clinical pathology. The panel is therefore relying more heavily on the MEB measurements; and, accordingly, after due deliberation, considering all 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 back condition.

BOARD FINDINGS: In the matter of the 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 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.

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