RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-04449
BRANCH OF SERVICE:  army 	SEPARATION DATE:  20060811

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Network Switch Systems Operator/Maintainer, medically separated for “chronic low back pain” with a disability rating of 0%.   

CI CONTENTION:  “I have two herniated discs that cause extreme pain and loss of feeling I have had one surgery and multiple pain injections.”  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 - 20060621	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain 	5243	0%	No VA Examination Proximate to Separation in Evidence	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Chronic Low Back Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI suffered an atraumatic onset of back pain in 2003.  He was diagnosed with disc disease by imaging (serial MRIs, central protrusions at L4/5 and L5/S1, no neural impingement).  There was STR documentation of intermittent left lower extremity radiation and sensory symptoms, but no subjective weakness.  Multiple examiners recorded normal neurological findings with normal (5/5) strength and there were no contrary entries.  Electrodiagnostic testing was normal.  Neurosurgery opined that surgery was not indicated.  There were multiple STR entries that documented grossly normal range of motion (ROM), although some noted non-specific ROM limitation and some noted painful motion.  There was STR documentation of a normal gait and normal spinal contour, with no contrary entries.  There was no STR documentation of incapacitating episodes.
  
The 25 April 2006 MEB NARSUM examination, 4 months prior to separation, documented pain rated 5/10 “aggravated by prolonged standing, running, and lifting heavy equipment.”  The physical examination recorded a normal gait without note of tenderness, spasm or abnormal contour.  Neurological findings were normal (5/5 strength, symmetric reflexes) except for a mild subjective sensory deficit localized to the great toe.  The ROM measurements conveyed in the NARSUM were identical to the measurements performed for the MEB by physical therapy (PT) on 13 April 2006.  After truncation these were flexion to 90 degrees (normal) and combined ROM of 230 degrees (normal 240), with painful motion.  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 low back condition 0%, coded 5243 (intervertebral disc syndrome), citing combined ROM “greater than 240 degrees.”  Members judged it likely that the PEB did not truncate measurements to the VASRD maximums in its calculation of combined ROM.

The panel agreed that a 10% rating, but no higher, was justified for combined ROM greater than 120 degrees but not greater than 235 degrees, as reported in the NARSUM and PT examination (the only goniometric evidence).  Additionally there was ample documentation of painful motion to support a minimum 10% rating.  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 incapacitating episodes that would provide for a higher rating under that alternate rating formula.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the back condition, coded 5243.  

BOARD FINDINGS:  In the matter of the back condition, the panel recommends a disability rating of 10%, coded 5243 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	
Lumbar Disc Disease	5243	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170515, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20180006650, 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