RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX.	CASE:  PD-2017-04563
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20051114

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

CI CONTENTION:  Condition continues to worsen and negatively impacts daily life and 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 - 20050510	VARD - 20051215	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Low Back Pain 	5299-5242	10%	DDD, Lumbar Spine	5243	10%	20050812	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Low Back Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s back condition began while deployed in 2003-2004 without specific injury or trauma.  X-rays of the lumbar spine showed moderate disk space narrowing at L5-S1 and mild to moderate narrowing at L4-L5.  MRI of the lumbar spine demonstrated advanced degenerative changes at L4-L5 and L5-S1 with mild bilateral foraminal narrowing.  Orthopedics determined he was not a surgical candidate.  

At the 12 August 2005 VA Compensation and Pension (C&P) examination, 3 months before separation, the CI reported low back pain, numbness and weakness in the left leg, aggravated by exercise, lifting, prolonged sitting, running, walking and bending.  He reported flare-ups with pain at 9/10 occurring two or three times per week and lasting 1 day.  He was unable to perform any activities and sometimes required assistance for activities of daily living.  Physical examination showed a normal appearing lumbar spine with tenderness, but no muscle spasm.  Straight leg raise testing was positive at 20 degrees, but he had normal motor strength.  The range of motion (ROM) evaluation showed flexion of 90 degrees (normal) and combined ROM of 170 degrees (normal 240) with painful motion.  

At the 27 September 2005 MEB NARSUM examination, 2 months prior to separation, the CI noted complaints of dull, persistent low back pain with exacerbations of 9/10 pain.  Aggravating factors included prolonged standing or sitting, lifting heavy objects or equipment and wearing a ballistic helmet or body armor.  The focused physical examination showed the lumbar spine to be midline and straight without scoliosis and he had normal heel-to-toe gait, but there was spinal tenderness.  The ROM was noted to be normal and full.  There was no radiculopathy noted on straight leg raise testing.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, coded 5299-5242 (degenerative arthritis of the spine), citing tenderness and pain limited motion.  The VA also rated the back condition 10%, coded 5243 (intervertebral disc syndrome), based on the C&P examination, citing active ROM coupled with clinical findings of pain and tenderness and radiographic evidence of degenerative process.   

The panel agreed that a 10% rating, but no higher, was justified for limitation of combined ROM (greater than 120 degrees but not greater than 235 degrees), as reported on the VA examination.     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 due to intervertebral disc syndrome 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 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:

[AR Number], XXXXXXXXXX 

Dear Mr. Smith:

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.