RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXX	CASE:  PD-2017-04277
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20071018

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 “chronic low back pain…without motor or neurologic abnormality” with a disability rating of 10%.  

CI CONTENTION:  Review requested of the back condition, which was rated higher by the VA, as well as an additional condition (PTSD) 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 - 20070912	VARD - 20080910	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5299-5242	10%	Lumbar Strain, with L4-5 and L5-S1 Disc Disease	5243	10%	20080617	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Low Back Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI initially injured his back while deployed in October 2006 after falling during an attack.  An MRI on 23 March 2007 revealed mild diffuse degeneration of the lumbar spine facets and broad-based left paracentral disc protrusions at L4-L5 and L5-S1 without impingement or displacement, but some narrowing of the left lateral recess.  At the MEB physical therapy (PT) examination on 18 July 2007, 3 months prior to separation, the CI reported low back pain, rated at 6/10, with intermittent numbness and tingling down the left leg to the heel.  On examination, there was localized tenderness and muscle spasm at the left L1-5 level.  Thoracolumbar range of motion (ROM), after repetition, showed flexion of 30 degrees (normal 90) and combined ROM of 145 degrees (normal 240), with painful motion.  The examiner measured flexion and extension with an inclinometer. 

The 24 August 2007 MEB NARSUM examination, 2 months prior to separation, noted CI complaints of constant back pain, which ranged from sharp to dull.  He had frequent lower back muscle spasms and stiffness aggravated by lifting, riding in vehicles, bending, running, twisting motions, sitting, sit ups, push-ups, jumping, ruck marching and prolonged standing, or wearing personal protective equipment.  Physical examination showed paraspinal muscle spasm and tenderness, normal strength and sensation, and deep tendon reflexes of 2+ at the knees and ankles, with no clonus.  

At the 17 June 2008 VA Compensation and Pension (C&P) examination, 8 months after separation, the CI reported constant low back pain, but denied any incapacitation.  Physical examination showed tenderness but otherwise normal posture, gait and spinal curvatures.  Measured thoracolumbar ROM showed flexion of 80 degrees and combined ROM of 230 degrees, with painful motion.  There were no signs of intervertebral disc syndrome (IVDS) with chronic or permanent nerve root involvement.  

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 thoracolumbar ROM limited by pain, and tenderness and spasm present with a normal gait.  The VA also rated the low back condition 10%, but coded 5243 (IVDS), based on the C&P examination, citing thoracolumbar flexion to 78 degrees with pain at 75 degrees of flexion.  Panel members agreed that a 10% rating, but no higher, was justified for limitation of flexion (greater than 60 degrees but not greater than 85 degrees) and/or combined ROM (greater than 120 degrees but not greater than 235 degrees), as reported on the VA examination most proximate to separation.  Although the MEB PT examination showed flexion of 30 degrees (40% rating), the examiner measured the flexion and extension with an inclinometer rather than the goniometric thoracolumbar ROM specified by the VASRD (§4.71a, Plate V).  Therefore, the panel considered the PT examination to have less probative value. 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.  Additionally, 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 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.   

The following documentary evidence was considered:  

	PD-2017-04277

AR20190011777, XXXXXXXXXXXXXXXXXXXXXX 

Dear XXXXXXXXXXXXXXX

	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.