RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-04334
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20060306

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

CI CONTENTION:  In addition to the back condition, the CI requested review of a condition 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 - 20060204	VARD - 20060412	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Low Back Pain	5243	10%	Status Post Total L5-S1 Discectomy 	5299-5237	20%	20060227	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Low Back Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent L5-S1 discectomy in April 2004 followed by L5-S1 disc replacement surgery in February 2005.  The CI had a vast improvement in his back pain, however, he continued to have left leg and foot numbness.  During the 22 September 2005 MEB examination (recorded on DD Forms 2807-1 and 2808), 6 months prior to separation, the CI reported left leg and foot numbness.  Physical examination noted decreased spine range of motion (ROM), but without measurements.  The 23 November 2005 MEB NARSUM examination, 5 months prior to separation, noted complaints of ongoing chronic low back pain and left leg numbness.  Physical examination showed 4+/5 motor weakness and subjectively decreased sensation in the left lower extremity, but reflexes were normal.  The ROM evaluation was incomplete, but showed flexion of 45 degrees (normal 90). 

At the 12 April 2006 VA Compensation and Pension (C&P) examination, 1 week before separation, the CI reported intermittent low back pain.  Physical examination showed a normal gait, but there was no spasm.  The ROM study showed flexion of 45 degrees with pain and combined ROM of 180 degrees (normal 240).  The left foot was very weak with toe walking compared to the right foot.  Sensory testing was abnormal throughout the left buttock, posterolateral thigh, throughout the calf, and most of the sole of the foot and toes.  Left leg position sense was delayed compared to the right.  Vibration sense was absent on the left.  The left Achilles reflex was absent.  Babinski test on the sole of the left foot was unresponsive.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, coded 5243 (intervertebral disc syndrome).  The VA rated the back condition 20%, analogously coded 5299-5237 (lumbosacral strain) based on the C&P examination citing limitation of forward 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 reported on the both NARSUM and C&P examinations.  A higher evaluation of 40% was not warranted in the absence of favorable ankylosis of the entire thoracolumbar spine.  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 the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 20% for the back condition, analogously coded 5299-5237.  

BOARD FINDINGS:  In the matter of the back condition, the panel recommends a disability rating of 20%, analogously coded 5299-5237 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	5299-5237	20%	

The following documentary evidence was considered:

AR20190004402, XXXXXXXXXX

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 and to the counsel you listed on your application.