RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXX		CASE: PD-2017-04254 BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20050410

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Automated Logistics Specialist, medically separated for “chronic low back pain” with a disability rating of 10%.

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 - 20050210	VARD - 20060306	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5299-5242	10%	Degenerative Disc Disease, Lumbar Spine	5243	20%	20060131	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 50%	

ANALYSIS SUMMARY:

Low Back Pain. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s low back condition began in 1997 after a military vehicle accident. A lumbar spine MRI on 15 April 2004 revealed a mild to moderate right paracentral disc herniation at L5- S1 which contacted the right S1 nerve root, and a mild disc bulge at L4-5. Electrodiagnostic testing in May 2004 was normal. The 17 November 2004 MEB NARSUM examination, 5 months prior to separation, noted CI complaints of intermittent low back pain with some radiation into the right leg. Severe pain occurred 3-5 days per month along with some constant mild pain. Physical examination from 5 October 2004 revealed mild tenderness over the L4-5 and S1 areas. Range of motion (ROM) was full, straight leg raise (SLR) testing (for radicular signs) was negative, and deep tendon reflexes (DTR) were 2+ and equal.

At the physical therapy visit on 7 February 2005, 2 months before separation, the CI reported on- and-off low back pain rated at 2/10. On examination, gait, stance and reflexes were normal. There was tenderness over the lumbar-thoracic junction with mild tenderness over the sacroiliac joints, but SLR testing was negative and there were no sensory or motor abnormalities. Thoracolumbar ROM measurements showed flexion of 110 degrees (normal 90) and a combined ROM of 175 degrees (normal 240).

At the 31 January 2006 VA Compensation and Pension (C&P) examination, 10 months after separation, the CI reported daily low back pain, rated at 6/10, with flare-ups twice a month, rated at 9-10/10 and precipitated by sitting. Physical examination showed some difficulty with heel and toe walking, but lower extremity reflexes and sensation were normal. Flexion was to 45 degrees with a combined ROM of 185 degrees, and the examiner noted she “could barely do 45 degrees before she started getting pain.” The main functional impact was pain, muscle weakness, fatigue and lack of endurance. Lumbar spine X-rays on 31 January 2006 were negative.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the low back condition 10%, analogously coded 5242 (degenerative arthritis of the spine), citing tenderness to palpation. The VA rated the low back condition 20%, coded 5243 (intervertebral disc syndrome (IVDS)), based on the C&P examination, citing limitation of thoracolumbar forward flexion to 60 degrees or less. Panel members noted that the VA ROM measurements were significantly worse than those reported by the MEB and PT examiners. However, there was no record of recurrent injury or other development in explanation of the more marked impairment reflected by the VA. While ROM limitations may have progressed over time, there was no evidence from which to conclude that the severity at the time of separation approached that portrayed by the VA measurements. Thus, the panel determined that the MEB and PT examinations carried greater probative value as they were closer to separation, more consistent with the STR, and more reflective of the anticipated severity based on the clinical pathology. Although there was insufficient limitation of motion in the examinations to support any rating above 10% (even if the missing rotation measurements were speculated as being zero degrees), panel members agreed that a 10% rating was justified for the presence of tenderness. 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. There was also 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 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.

AR20190012705, XXXXXXXXXXXXXXXXXXXXXXX 

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.