RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXXXXXX	CASE: PD-2017-04805
BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20071226

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Power Generator Mechanic, medically separated for “low back pain” with a disability rating of 0%.

CI CONTENTION: “Issue has gotten worse. Not able to work in my field of training.” Review requested of additional conditions (PTSD and TBI) not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB).  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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the 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 - 20071109	VARD - 20080813	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5299-5243	0%	Degenerative Disc Disease, Lumbar Spine	5010-
5242	20%	20080310	
COMBINED RATING: 0%	COMBINED RATING OF ALL VA CONDITIONS: 40%	

ANALYSIS SUMMARY:

Chronic Low Back Pain (LBP). According to the service treatment record and MEB narrative summary (NARSUM), the CI’s low back condition began in 2002 with no specific trauma or incident. An MRI in July 2007 revealed a right central disc herniation at L3-L4, and a broad-based disc herniation protrusion at L4-L5 with canal stenosis due to short pedicles and disc herniation. In October 2007, electro-diagnostic studies were normal, and the CI was treated extensively with physical therapy (PT) and medications. The 9 October 2007 MEB NARSUM examination, 3 months prior to separation, noted complaints of LBP, and the examiner recorded a normal  gait

and spinal contour, with no localized tenderness, muscle spasm, or guarding. Neurological findings were normal, with the exception of a depressed right ankle reflex and no Babinski’s sign.

At the 18 October 2007 physical medicine and rehabilitation service examination, 2 months before separation, the CI reported chronic LBP with lower extremity radicular pain to the left knee. Physical examination showed tenderness and decreased ROM, but normal strength The provider requested EMG/NCV studies, which were normal. Thoracolumbar range of motion (ROM) measurements by PT the next day showed flexion of 60 degrees (normal 90) and combined ROM of 165 degrees (normal 240) after repetition and with painful motion in all planes.

During the 10 March 2008 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported intermittent LBP aggravated by prolonged sitting, standing and repetitive bending and heavy lifting. He had to lie down at least 5 times a month after flare-ups. Physical examination showed normal gait, stance and coordination with mild paraspinal tenderness over the lower lumbar spinal region. Neurological, sensory, or motor findings were normal and thoracolumbar flexion was to 60 degrees with a combined ROM of 175 degrees. Painful motion was noted in all planes, and there was increased muscle weakness and pain with repetitive ROM, particularly with forward flexion, but no additional ROM loss.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the low back condition 0%, analogously coded 5243 (intervertebral disc syndrome (IVDS)), citing flexion limited to 65 degrees by pain alone. The VA rated the low back condition 20%, dual coded 5010-5242 (arthritis, due to trauma-degenerative arthritis of the spine), based on the C&P examination, citing thoracolumbar forward flexion greater than 30 degrees but not greater than 60 degrees. The panel agreed that a 20% rating, but no higher, was justified for limitation of flexion, as reported on the MEB PT and VA examinations. There was no documentation of IVDS with incapacitating episodes for a higher rating under that formula. After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 20% for the low back condition, coded 5299-5243.

BOARD FINDINGS: In the matter of the low back condition, the panel recommends a disability rating of 20%, coded 5299-5243 IAW VASRD §4.71a. There are no other conditions within the panel’s scope of review for consideration.

The panel recommends the CI’s prior determination be modified as follows, effective the date of medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Low Back Pain	5299-5243	20%	

The following documentary evidence was considered:

2	PD-2017-04805

DEPARTMENT OF THE ARMY
ARMY REVIEW BOARDS AGENCY 251 18TH STREET SOUTH, SUITE 385
ARLINGTON, VA 22202-3531

[AR NUMBER]

Dear XXXXXXXXXXXXXXX:

The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability. I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation. This will not result in any change to your separation document or the amount of severance pay. A copy of this decision will be filed with your Physical Evaluation Board records. I regret that the facts of the case did not provide you with the outcome you may have desired.

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.

A copy of this decision has also been provided to the Department of Veterans Affairs.

Enclosure

Printed on	Recycled Paper