RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXXXXX	CASE: PD-2017-04114
BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20061117

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

CI CONTENTION: The CI requested review of additional conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB). 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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the 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 - 20060929	VARD - 20070626	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic LBP	5299-5237	10%	Intervertebral Disc Syndrome (IVDS) with Mild Disc Narrowing	5237	10%	20070523	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 20%	

ANALYSIS SUMMARY:

Chronic LBP. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s back condition began in April 2004 when he noted the insidious onset of thoracic and low back pain. Initially, there was no radiation of pain; however, with continued activity, there was intermittent radiation to the left leg and occasionally to the right leg advancing to the toes. He received conservative care at physiotherapy which produced relief of the thoracic back pain; however, the LBP continued and the CI was profiled and advised to make changes in physical activities which was moderately successful. In July 2005, he saw his local physicians who referred him for an MRI.     The MRI of the lumbosacral spine revealed disc bulging at L4 and L5,

with thecal contact and contact of the L4-L5 and L5-S1 nerve roots on the left. The CI was then referred to neurosurgery where an evaluation revealed a diagnosis of discogenic LBP. He was recommended for discography but declined the procedure and was not a candidate for surgery. Due to continued failure of conservative measures as well as injection therapy, he was presented with a permanent level 3 profile and recommended for MEB consideration. The 25 July 2006 MEB NARSUM examination, 4 months prior to separation, noted complaints of LBP and difficulty with prolonged standing, running, long walks, lifting, especially overhead, and with riding for prolonged periods in military tactical vehicles. Physical examination revealed no gross abnormalities. All ranges of motion (ROM) were limited by pain. A straight leg raise test was normal and there was no obvious atrophy. On examination of the low back paravertebral muscle spasm was noted, particularly on the left. There was no area of percussion pain noted on the spinous processes. He had a normal gait. During the 6 September 2006 physical therapy (PT) examination, 2 months prior to separation, the CI reported LBP with intermittent radiculopathy. Physical examination revealed thoracolumbar ROM measured by a goniometer was flexion of 55 degrees (normal 90) with a combined ROM of 170 degrees (normal 240).

At the 23 May 2007 VA Compensation and Pension (C&P) examination, 6 months after separation, the CI reported degenerative disc disease of the lumbar spine. Physical examination revealed thoracolumbar ROM flexion of 60 degrees and combined ROM of 190 degrees (normal 240). Muscle spasm was absent. There was tenderness over the lumbar spinous processes. Straight leg raise testing was negative. There was no ankylosis of the spine. His posture and gait were normal and he did not require an assistive device to ambulate.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the low back condition 10%, analogously coded 5299-5237 (lumbosacral strain), citing painful motion. The VA also rated the back condition 10%, coded 5237, based on the C&P examination, citing painful motion. The panel agreed that a 20% rating, but no higher, was justified for limitation of flexion greater than 30 degrees but not greater than 60 degrees as reported on the PT and VA examinations. There was no documentation of IVDS 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 recommends a disability rating of 20% for the back condition, coded 5237.

BOARD FINDINGS: In the matter of the chronic low back pain, the panel y recommends a disability rating of 20%, 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	5237	20%	

The following documentary evidence was considered:

	PD-2017-04114

AR20190011713, XXXXXXXXXXXXXXXXXXXX 

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.

	PD-2017-04114