RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-04458
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20061024

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a National Guard E4, Food Service Operations Specialist, medically separated for “chronic back pain” with a disability rating of 10%.   

CI CONTENTION:  No specific contention was made.  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 - 20061205	VARD - 20080117	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Back Pain	5299-5237	10%	Degenerative Disc Disease Lumbar Spine	5242	NSC	20070620	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10% 	

ANALYSIS SUMMARY:  

Chronic Back Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s back condition began in July 2005 while riding in a “bouncing” vehicle during convoy operations.  Lumbar spine MRI showed L4-S1 disc bulges without focal disc herniation.  Neurosurgery recommend non-surgical treatment options.  

During the 25 June 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 4 months prior to separation, the CI reported recurrent back pain with nerve damage on his leg.  Physical examination revealed moderate tenderness and a positive straight leg raise test.  The thoracolumbar range of motion (ROM) study showed 50 degrees of flexion (normal 90) and combined ROM of 135 degrees (normal 240) after rounding to the nearest 5 degrees.  Electrodiagnostic studies in July 2006 showed no evidence of lower extremity radiculopathy.  

At the 6 July 2006 primary care clinic evaluation, 3 months prior to separation, the CI reported pain in his low back, which limited his daily activities.  Physical examination showed tenderness and muscle spasm.  The ROM study showed flexion of 50 degrees and combined ROM of 125 degrees.  The 29 August 2006 MEB NARSUM examination, 2 months prior to separation, noted complaints of 5/10 back pain exacerbated by prolonged walking, sitting or standing with flare-ups to 8/10 three to five times per week.  Physical examination showed a normal gait with full ROM and normal strength in all extremities.  There was moderate tenderness and a positive straight leg raise.  Thoracolumbar ROM testing showed 50 degrees of flexion and 135 degrees of combined ROM.  Lumbar spine MRI showed bulging discs at L4-5 and L5-S1 and an L2 vertebral hemangioma.  

At the 20 June 2007 VA Compensation and Pension (C&P) examination, 8 months after separation, the CI reported 7-8/10 constant back pain radiating to the left leg with a history of decreased ROM, spasm and pain, but no history of urinary or fecal incontinence.  Precipitating factors were prolonged walking and sitting or kneeling.  Physical examination showed muscle spasm, tenderness and an antalgic gait, but the examiner noted the spasm and tenderness were not severe enough to be responsible for the abnormal gait.  There was no abnormal spinal contour or ankylosis noted, but X-rays showed straightening of lumbar lordosis.  Neurological examination was within normal limits.  The thoracolumbar ROM evaluation revealed 70 degrees of flexion after repetitive use and combined ROM of 220 degrees with painful motion.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, analogously coded 5299-5237 (lumbosacral strain), citing ROM limited by pain with localized tenderness.  The VA did not rate the condition, but instead found it to be not service connected (NSC).  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 MEB and NARSUM examinations proximate to separation.  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, coded 5299-5237.  

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

The following documentary evidence was considered:

AR20190004441, 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.