RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX. 	CASE:  PD-2017-04590
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070514

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, M1 Armor Crewman, medically separated for “low back pain” with a disability rating of 10%.  

CI CONTENTION:  The condition continues to worsen and negatively impacts 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 – 20070418	VARD – 20070627	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5299-5243	10%	Degenerative Disc Disease	5243	10%	20070510	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent a lumbar microdiscectomy at L5-S1 in November 2006 for a herniated disc.  The 4 February 2007 MEB NARSUM examination, 3 months prior to separation, noted complaints of back pain.  Physical examination showed a mildly antalgic gait, but there were no paraspinal muscle spasms or evidence of abnormal spinal contour.  Strength, reflexes and sensation were normal.  

During the 7 March 2007 MEB examination (recorded on DD Forms 2807-1 and 2808), 2 months prior to separation, the CI reported back pain.  Physical examination showed tenderness and pain with flexion.  Thoracolumbar range of motion (ROM) measurements, performed by physical therapy (PT) on 15 March 2007, showed pain limited flexion of 20 degrees (normal 90) and combined ROM of 130 degrees (normal 240), after repetition.   

At the 10 May 2007 VA Compensation and Pension (C&P) examination, 4 days before separation, the CI reported chronic low back pain.  Physical examination showed mild spasm and tenderness, but his gait was non-antalgic and there was no evidence of abnormal spinal contour.  The ROM evaluation showed flexion of 65 degrees and combined ROM of 190 degrees, after repetition.  The CI exhibited mild to moderate manifestations of pain and stiffness during the examination.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, analogously coded 5299-5243 (intervertebral disc disease), citing pain limited flexion of 22 degrees.  The VA also rated the back condition 10%, coded 5243, based on the C&P examination, citing flexion greater than 60 degrees but not greater than 85 degrees and combined ROM greater than 120 degrees but not greater than 235 degrees.    

In assigning probative value to these somewhat conflicting examinations, the panel noted the PT ROM study was performed only 4 months after surgery, but the VA examination was performed 6 months after surgery.  Panel members agreed the pre-separation VA examination, performed closer to separation, more accurately reflected the CI’s post-surgical functional impairment; therefore, the panel placed greater probative value on the VA examination.  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 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 intervertebral disc syndrome with incapacitating episodes which would provide for a higher rating under that formula.  After due deliberation, considering all of 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:

 [AR Number], XXXXXXXXXX.

Dear XXXXXXXXXX:

	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.