RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXX	CASE: PD-2017-03956
BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20080322

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6, Watercraft Operator, medically separated for “low back pain [LBP}” with a disability rating of 10%.

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 - 20080507	VARD - 20090413	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic LBP Post Discectomy	5243	10%	Intervertebral Disc Syndrome (IVDS) with Degenerative Changes, Thoracolumbar Spine, Post-Operative	5243	20%	20081028	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 80%	

ANALYSIS SUMMARY

Low Back Pain. According to the service treatment record (STR) and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent back surgery for an L4-L5 herniated disc in July 2005. He was attempting to get back in physical condition to return to full duty when he developed increasing back pain and right leg pain and paresthesias associated with running. He denied weakness. He had been in physical therapy (PT) with some improvement, however, the pain returned with running. A lumbar spine MRI on 18 October 2007, 5 months prior to separation, showed degenerative disc disease with post-surgical changes at L4-5 and scar tissue

in the right L5 lateral recess. There was a small central disc herniation at L5-S1 without nerve compression. The CI declined further injections or surgery. Thoracolumbar range of motion (ROM) measurements performed by PT on 4 December 2007, 4 months prior to separation, showed flexion of 75 degrees (normal 90) and combined ROM of 200 degrees (normal 240) after repetition.

The 19 December 2007 MEB NARSUM examination, 3 months prior to separation, noted complaints of chronic LBP. Physical examination showed the CI walked with a normal gait. There was no evidence of kyphosis, lumbar lordosis, or scoliosis, and no evidence of tenderness or spasm. Strength and reflexes were normal and a straight leg raise (SLR) test was negative bilaterally at 60 degrees.  Patrick’s test (hip pain) was also negative bilaterally.

At the 28 October 2008 VA Compensation and Pension (C&P) examination, 7 months after separation, the CI reported constant 8/10 LBP elicited by physical activity and which traveled down his legs and was described as squeezing, aching and sharp . The CI reported incapacitating episodes of unspecified duration in October 2008. On physical examination the CI had a normal gait. Inspection of the spine revealed normal head position with symmetric appearance and symmetry of spinal motion with normal curves of the spine. There was evidence of radiating pain on movement into the lower extremities. Muscle spasm and tenderness were both present in the “lumbar spine area” and SLR testing was negative bilaterally. There was no ankylosis of the lumbar spine. Thoracolumbar ROM was flexion of 70 degrees and combined ROM of 175 degrees after repetition. Joint function of the spine was additionally limited by the following after repetitive use: pain, fatigue, weakness, lack of endurance, incoordination, and pain had the major functional impact. There was no additional limitation in degrees. Thoracic spine X-rays showed slight scoliosis and lumbar spine X-rays showed joint narrowing.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the low back condition 10%, coded 5243 (IVDS), citing a rating for forward flexion between 61 and 85 degrees. The VA rated the low back condition 20%, coded 5243, based on the C&P examination, citing evidence of muscle spasm with scoliosis.

The panel agreed that a 10% rating, but no higher, was justified for limitation of flexion and combined ROM (greater than 120 degrees but not greater than 235 degrees), as reported on the MEB PT and C&P examinations proximate to separation. Although there was muscle spasm in the lumbosacral area noted on the VA examination, the CI’s gait was normal and slight thoracic scoliosis noted on X-rays was not likely related to the muscle spasm as supported by normal symmetrical appearance of the spine, symmetry with spinal motion, and normal spinal curvatures noted on the same examination. Thus, the next higher 20% rating was not justified on this basis. There was no documentation of IVDS with incapacitating episodes with a total duration of 2 weeks or more 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 low back condition.

BOARD FINDINGS: In the matter of the low 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 following documentary evidence was considered:
PD-2017-03956

AR20190010926, XXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXX

	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.

PD-2017-03956