RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-04499
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080806

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

CI CONTENTION:  The rating was too low and the back condition continues to worsen and negative impact daily activities.  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 - 20080515	VARD - 20080913	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5242	10%	Lumbar Spine Degenerative Disc Disease 	5242	10%	20080619	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain (LBP).  According to the service treatment record and MEB narrative summary (NARSUM), the CI first sought medical care for his back at a primary care visit on 7 July 2006, reporting a history of back pain for “as long as he can remember…since a small kid.”  He denied any trauma or injury but reported pain that had become more frequent.  Spine X-rays showed minimal degenerative disc disease (DDD) at L2-3, but were otherwise normal.  He was able to complete a 14-month deployment to Iraq, but experienced increased LBP late in the deployment which worsened upon return.  In February 2008, X-rays showed mild spondylotic changes at L2-3 and small Schmorl’s nodes with intervertebral body disc herniations at L3-4 and L4-5.  At an orthopedic appointment on 26 February 2008, 5 months before separation, he reported LBP that had not improved with physical therapy (PT) or chiropractic care, precluded him from wearing body armor, and impacted physical training; but he denied radiation.  Physical examination showed no lumbar spine tenderness, normal lower extremity strength, sensation, and reflexes bilaterally, and full, but painful, back range of motion (ROM).  An MRI in March 2008 revealed mild DDD and spondylotic changes at L2-3.  The 25 April 2008 PT ROM evaluation for the MEB, 3 months prior to separation, showed goniometrically measured thoracolumbar flexion of 75 degrees (normal 90) and combined ROM of 220 (normal 240), with mild, right sided paraspinal guarding at L1-3.  At the 30 April 2008 MEB NARSUM examination, the examiner documented a normal gait with no muscle spasm, full back ROM, and normal lower extremity muscle strength.  Painful motion was not noted.  

At the 19 June 2008 VA Compensation and Pension (C&P) examination, 2 months before separation, the CI reported LBP that prevented him from doing physical training.  The examiner recorded full ROM, with painful motion, and the absence of ankylosis, abnormal spinal contour, spasm, or radiculopathy. The CI declined corrective surgery, preferring conservative treatment.

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 forward flexion of 70-75 degrees and combined ROM of 215 degrees.  The VA also rated the back condition 10%, coded 5242, based on the C&P examination, citing painful motion.  Panel members 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 examination.  The C&P examination showed full ROM but reported painful motion, which also supports a 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 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 adjudication for the back condition.  

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.  

The following documentary evidence was considered:

AR20190007300, XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX

	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.