RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX 	CASE:  PD-2017-04781
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050720

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

CI CONTENTION:  Review all conditions.  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 - 20050622	VARD - 20050816	
Condition	Code	Rating	Condition	Code	Rating	Exam	
…Low Back Pain 	5299-5237	10%	Degenerative Disc Disease, Thoracolumbar Spine 	5242	20%	20050719	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Low Back Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s back condition began in February 2001 while playing basketball.  An April 2005 MRI revealed an annular bulge at L4/5; surgery was not indicated.  Thoracolumbar range of motion (ROM) measurements for the MEB, performed by physical therapy (PT) on 8 April 2005, showed flexion of 85 degrees (normal 90) and combined ROM of 205 degrees (normal 240), after repetition, with pain on end range of flexion and extension.  The CI was able to heel-to-toe raise ten times without difficulty.  During the 23 May 2005 MEB examination (recorded on DD Forms 2807-1 and 2808), 2 months prior to separation, the CI reported recurrent back pain with left leg numbness.  Physical examination revealed no radicular signs, atrophy or spasms.  The ROM evaluation showed flexion of 90 degrees and combined ROM of 230 degrees, with discomfort (pain) on forward flexion. 

At the 19 July 2005 VA Compensation and Pension (C&P) examination, 1 day before separation, the CI reported constant low back pain, rated at 10/10, but denied incapacitation or lost time from work.  Physical examination showed normal gait and posture without muscle spasm or tenderness, and no signs of intervertebral disc syndrome (IVDS).  Flexion was to 40 degrees with a combined ROM of 155 degrees and painful motion.  The examiner stated he was unable to determine, without resorting to speculation, on whether pain, fatigue, weakness, lack of endurance or incoordination additionally limited ROM.  

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 thoracolumbar ROM of 260 degrees.  The VA rated the thoracolumbar spine condition 20%, coded 5242 (degenerative arthritis of the spine), based on the C&P examination, citing forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees.  In assigning probative value to these somewhat conflicting examinations, members noted that the MEB measurements were consistent with the proximate PT examination.  The ROM values reported by the VA examiner were significantly worse, and the panel was unsure if the CI attempted thoracolumbar spine excursion to full painful limits or stopped when pain occurred.  The significant VA ROM limitations were not corroborated by objective findings of spasm or guarding, and there was no record of recurrent injury or other development to explain the more marked impairment reflected by the measurements. Therefore, the panel consensus was that preponderant probative value should be assigned to the MEB and PT ROM evaluations.  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) or combined ROM (greater than 120 degrees but not greater than 235 degrees).  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 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 low back pain 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], XXXXXXXXXXXXXXXXXX

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.

Enclosure