RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03960
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050714

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Health Care Specialist, medically separated for “chronic low back pain” with a disability rating of 0%.  

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’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 - 20050419	VARD - 20051122	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5299-5237	0%	Lumbar Strain 	5236-5237	10%	20051004	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  40% 	

ANALYSIS SUMMARY:  

Low Back Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s back condition began atraumatically in March 2002.  Medication, physical therapy (PT) and chiropractic care proved unsuccessful.  MRI performed on 5 March 2005 showed no evidence of abnormality.  At the 2 December 2004 PT evaluation, approximately 7 months prior to separation, the CI reported low back pain.  Thoracolumbar lumbar range of motion (ROM) measurements showed flexion of 40 degrees (normal 90) and combined ROM of 120 degrees (normal 240) with pain.  Measurements were taken with a goniometer, with the exception of an inclinometer for rotation.  

The 30 March 2005 MEB NARSUM examination, 4 months prior to separation, noted complaints of low back pain.  Physical examination showed an upright posture with increased lumbar lordosis, but readily reversed curve with flexion.  The CI was able to reach her mid legs with her fingertips.  Motor strength, deep tendon reflexes and sensation were normal.  ROM measurements showed flexion of 80 degrees and a combined ROM of 220 degrees.  The flexion and extension measurements were done with an inclinometer.  

At the 4 October 2005 VA Compensation and Pension (C&P) examination, 3 months after separation, the CI reported that cold weather aggravated her symptoms and resulted in constant left lower back pain.  Physical examination showed a normal gait, but there was tenderness.  Motor strength, sensation and deep tendon reflexes were normal.  ROM flexion was 80 degrees and combined ROM of 200, with pain.  X-rays showed a normal lumbar spine.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 0%, analogously coded 5299-5237 (lumbosacral strain), citing pain limited flexion to 80 degrees.  The VA rated the back condition 10%, dual coded 5236-5237 (sacroiliac injury and weakness - lumbosacral strain), based on the C&P examination, citing combined ROM of the thoracolumbar spine limited to 200 degrees, with pain.  Greater probative value was given to the C&P examination for most proximate time to separation and all measurements were IAW VASRD 4.46.  The panel noted the more proximate MEB NARSUM measurements were in concert with the VA C&P examination versus the PT evaluation.  The panel noted there was sufficient limitation of forward flexion or combined ROM to support a 10% rating according the MEB NARSUM and C&P examinations.  The panel also noted that a 10% rating was justified for the presence of painful motion and tenderness in the C&P examination, but this provided no rating benefit to the CI.  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.  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 5299-5237.  

BOARD FINDINGS:  In the matter of the back condition, the panel recommends a disability rating of 10%, 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	5299-5237	10%	

AR20180016607, XXXXXXXXXXXXXXXXXX

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.