RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXX 	CASE:  PD-2017-04489
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, Motor Transport Operator, medically separated for “low back pain [LBP]” with a disability rating of 10%.   

CI CONTENTION:  Review of all conditions requested. 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 – 20060131	VARD - 20061116	
Condition	Code	Rating	Condition	Code	Rating	Exam	
LBP	5242	10%	DDD of the Lumbosacral Spine	5243	10%	20061005	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Low Back Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI reported a 7-year history of back pain.  The 8 December 2005 line of duty memorandum reported, he injured his lower back during a parachute landing.  An MRI in 1998 revealed degenerative disc disease (DDD) and a follow-up MRI in April 2003 noted DDD and a mild protruded disc at L5-S1.  The CI underwent physical therapy (PT) and chiropractic care over the years without any permanent benefit.

Thoracolumbar range of motion (ROM) measurements performed by PT on 17 November 2005, 4 months prior to separation, showed flexion of 80 degrees (normal 90) and combined ROM of 195 degrees (normal 240) after repetition. Pain was the reason for limitation.  Measurements were taken with a bubble inclinometer. During the next-day MEB examination (recorded on DD Forms 2807-1 and 2808), the CI reported recurrent LBP since 1998.  Physical examination revealed tenderness at L5-S1, painful decreased ROM and a normal gait.  Lower extremity strength and reflexes were normal.  The 27 December 2005 MEB NARSUM examination noted complaints of LBP, severe at times with certain motions, as well as increased pain with prolonged sitting, standing or driving.  The pain was not responsive to medication or conservative care.  Physical examination showed a normal gait, erect posture and limited ROM in all planes due to pain.  

At the 5 October 2006 VA Compensation and Pension (C&P) examination, 7 months after separation, the CI reported a chronic dull aching-type LBP aggravated by extended sitting or standing.  Physical examination showed slight spasms to the left and right paravertebral areas.  Gait was noted as “generalized stiffness but appeared to be strong and steady.”  Tenderness was also noted.  Alignment appeared adequate.  Flexion was 70 degrees with pain and combined ROM was 190 degrees; there was no change after five repetitions.   

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, coded 5242 (degenerative arthritis of the spine), citing tenderness and ROM limited by pain.  The VA rated the back condition 10%, coded 5243 (intervertebral disc syndrome [IVDS]), based on the C&P examination, citing evidence of some loss of motion due to pain as well as muscle spasm.    

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/or combined ROM (greater than 120 degrees but not greater than 235 degrees), as reported on the MEB PT and VA examinations. 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 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-2017-04489

AR20190011351, XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXX

	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.