RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXX	CASE:  PD-2017-04438
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20071210

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

CI CONTENTION:  “The second and third order effects of my back injury include knee, impotence and decreased quality of life.”  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 - 20071001	VARD - 20080228	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5299-5237	10%	Degenerative Changes of the Lumbar Spine	5242	10%	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain (LBP).  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s non-radicular LBP began in November 2004 after repetitive bending.  An MRI of the lumbar spine performed in October 2006 noted mild degenerative changes without focal herniation.  

The 3 August 2007 MEB examination (recorded on DD Form 2808), 4 months prior to separation, documented decreased lumbar spine lordosis (abnormal spinal contour).  There was no comment with regards to the presence of either muscle guarding or spasms.   At the 28 August 2007 MEB NARSUM examination, 3 months prior to separation, the CI complained of “chronic LBP.”  Physical examination (PE) noted tenderness without spasm, a normal gait and a “normal appearing” lumbosacral spine.  On 19 September 2007, the physical therapy PT range of motion (ROM ) study of the thoracolumbar spine showed flexion of 75 degrees (normal 90) and combined ROM of 190 degrees (normal 240).  Muscle guarding and painful motion were present.  There was no VA examination proximate to separation in evidence.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the LBP 10%, analogously coded as 5237 (lumbar spine strain), citing the presence of spinal tenderness.  The VA also rated the LBP 10%, coded 5242 (degenerative arthritis of the spine), based on the STR, citing limited and painful motion.

The panel 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 combined ROM (greater than 120 degrees but not greater than 235 degrees), as reported on the  PT examination.  Panel members agreed the presence of abnormal spinal contour as noted on the DD Form 2808 in early August 2007 was normalized nearly 1 month later when the NARSUM provider noted a “normal appearing” lumbar spine.  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 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 concluded there was insufficient cause to recommend a change in the PEB’s adjudication of the LBP.

BOARD FINDINGS:  In the matter of the 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.  

[AR Number], XXXXXXXXXXXXX 

Dear  XXXXXXXXXXX:

	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.
 
	A copy of this decision has been provided to the counsel you listed on your application; [name and address].