RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX 	CASE:  PD-2017-03952
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20051013

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

CI CONTENTION:  Complications of the unfitting condition required surgeries in 2016.  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 - 20050929	VARD - 20060707	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Back Pain	5237	10%	Lumbar Spine Degenerative Disc Disease 	5237	10%	20060228	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Chronic Back Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s back condition began as early as April 1998 and was exacerbated in November 2002 after heavy lifting.  An MRI dated 15 January 2003 showed disc bulges at the L4-L5 and L5-S1 levels without herniation or stenosis.  The CI underwent physical therapy on multiple occasions, acupuncture on 29 March 2004, and chiropractic care on 13 April 2004.  An undated note after the chiropractic visit indicated flexion of 90 degrees (normal) without pain or crepitus (grinding sensation).  The examiner felt the lower back pain (LBP) was consistent with a mechanical etiology which was non-surgical.  On 21 July 2004 the CI reported LBP and received an injection of Toradol (ketorolac, a nonsteroidal anti-inflammatory drug) and was prescribed Flexeril (cyclobenzaprine, a muscle relaxer).  At a physical medicine and rehabilitation visit on 10 August 2004, he reported LBP and underwent acupuncture.  On examination he had mild tenderness of the bilateral lumbar paravertebral muscles.  The 4 August 2005 MEB NARSUM orthopedic addendum examination, 2 months prior to separation, noted complaints of ongoing LBP with occasional radiating pain into the right buttock, “but no real sciatica.”  Physical examination showed the lumbosacral range of motion (ROM), measured with a goniometer, showed flexion of 40 degrees, which is equivalent to 70 degrees of thoracolumbar motion, and combined ROM of 220 degrees (normal 240).  There was tenderness in the lumbosacral area and the spine appeared straight.    

At the 28 February 2006 VA Compensation and Pension (C&P) examination, 5 months after separation, the CI reported frequent radiating LBP rated 3-4/10 in severity, with flares to 5-6/10, brought on by lifting or bending, which caused decreased ROM and decreased ability to work.  Physical examination showed a normal gait, posture, and spinal curvature.  The examiner recorded the flexion of 90 degrees and combined ROM of 195 degrees, with painful motion noted.  Neurologic examination was normal.  The examiner’s diagnosis was degenerative disk disease of L2-L3 and L5-S1 with bulging disks at levels noted on the MRI of 2003, and with a mild degree of functional impairment.  X-rays of the lumbar spine confirmed the diagnosis.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB and VA both rated the back condition 10%, coded 5237 (lumbosacral strain).  The VA based the rating 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 agreed that a 10% rating, but no higher, was justified for limitation of flexion (greater than 60 degrees but not greater than 85 degrees) and/or combined ROM (greater than 120 degrees but not greater than 235 degrees), as variously reported on the orthopedic and VA C&P examinations.  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 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 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.  

AR20190010920, XXXXXXXXXXXXXXXX 

Dear XXXXXXXXXXX:

	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.