RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX 	CASE:  PD-2017-04169
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070227

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a National Guard E5, Infantryman, medically separated for “chronic low back pain” with a disability rating of 0%.  

CI CONTENTION:  “Back injury should have been rated higher.”  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 - 20061219	VARD 20080805	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5299-5242	0%	Chronic Sprain, Lower Back	5237	10%	20080323	

ANALYSIS SUMMARY:  

Chronic Low Back Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s back condition began in November 2004 while riding in a vehicle over rough terrain.  The 28 September 2006 MEB NARSUM examination, 5 months prior to separation, noted complaints of daily back pain, exacerbated by prolonged sitting or standing.  Additionally documented was “episodic radicular symptoms,” but no quantification or directional extent was described.   The physical examination (PE) revealed no significant focal spinal tenderness and the CI’s gait was normal.  Thoracolumbar range of motion (ROM) measurements performed by physical therapy (PT) recorded active flexion to 45 degrees (normal 90) and combined ROM of 195 degrees (normal 240), after repetition, with pain in all directional movements.  

At the 23 March 2008 VA Compensation and Pension (C&P) examination, 13 months after separation, the CI reported pain in the lower spine that was constant and radiated down both legs.  Pain was elicited with physical activity and stress.  The CI’s posture and gait were normal.  Thoracolumbar ROM measurements were active flexion to 30 degrees and combined ROM of 180 degrees, after repetitive motion.  Spinal motion was not additionally limited secondary to pain, fatigue, weakness, lack of endurance or incoordination.  There was no evidence of a clinical radiculopathy.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 0%, analogously coded 5299-5242 (degenerative arthritis), citing ROM limited by pain.  The VA rated the back condition 10%, coded 5237 (lumbosacral strain), based on the C&P examination, citing forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees.  The panel considered the examinations in evidence and agreed the pre-separation NARSUM examination held the most probative value, given its proximity to separation.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel agreed the pre-separation examination supported no greater than a 20% rating for limitation of spinal motion noting forward flexion to 45 degrees.  

BOARD FINDINGS:  In the matter of the back condition, the panel recommends a disability rating of 20%, analogously coded 5299-5242 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	5299-5242	20%	

The following documentary evidence was considered:

AR20190004445, XXXXXXXXXX 

XXXXXXXXXX
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Dear XXXXXXXXXX:

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.