RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE: pd-2017-04217
BRANCH OF SERVICE:  army	SEPARATION DATE:  20070209

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

CI CONTENTION:  The CI stated that he should have been rated higher, and there were additional conditions that were not considered by the 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 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 - 20061107	VARD - 20070412	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5299-5242	10%	Sprain/Contusion, Lumbar Spine	5243-5237	20%	20061102	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:

Low Back.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s back condition began in December 2003 after falling off a rope climb.  Over the next 3 years, the CI had frequent minor injuries which aggravated his condition.  Radiographic imaging revealed a probable benign tumor at L3, but there was no surgical indication.  At the 15 June 2006 Physical Therapy (PT) evaluation, 8 months before separation, the CI reported low back pain that radiated down the left leg.  His physical examination (PE) revealed lumbosacral range of motion (ROM) of forward flexion to 60 degrees (normal 90), combined ROM was incomplete and painful motion was not addressed.  At the 13 July 2006 MEB NARSUM examination, 7 months prior to separation, the CI reported chronic low back pain.  The examination revealed spinal muscle spasms.  Lumbosacral ROM was forward flexion to 45 degrees and combined ROM of 145 (normal 240); painful motion was not addressed.  

During the 2 November 2007 VA Compensation and Pension (C&P) general evaluation, 3 months before separation, the CI endorsed constant low back pain which extended into the left hip and leg with activity.  The PE revealed a normal gait and posture.  There were no spinal muscle spasms, but spinal tenderness was present.  Lower extremity motor strength and sensory function were within normal limits.  ROM was flexion to 45 degrees and combined ROM was 195 degrees; painful motion was present. 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition at 10%, analogously coded 5299-5242 (degenerative arthritis of the spine) citing spinal tenderness.  The VA rated the back condition at 20%, dual coded 5243-5237 (intervertebral disc disease-lumbosacral strain), based upon the C&P evaluation 3 months before separation, citing limitation of flexion.  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 recorded by the PT, MEB NARSUM and VA examinations proximate to separation.  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 of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 20% for the back condition.

BOARD FINDINGS:  In the matter of the back condition, the panel 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 as of the date of the prior medical separation.

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Low Back Pain	5237	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170524 w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20180006263 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. 

Sincerely,					      
Enclosure