[AR Number], XXXXXXXXXX 

XXXXXXXXXX
XXXXXXXXXX
XXXXXXXXXX

Dear XXXXXXXXXX:

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.

Sincerely,					      

Enclosure

RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-04842
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20061020

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Patriot Operator/Maintainer, medically separated for “chronic 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 - 20060920	VARD - 20070706	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5241	10%	Status Post Disc Extrusion at L5-S1	5242-5243	20%	20061012	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Low Back Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent back surgery with discectomy and fusion on 26 June 2006.  The 1 August 2006 physical therapy (PT) MEB thoracolumbar range of motion (ROM) evaluation, 3 months prior to separation, showed flexion of 60 degrees (normal 90) and combined ROM of 165 degrees (normal 240), after repetition.   The 19 August 2006 MEB NARSUM examination, 3 months prior to separation, noted complaints of low back pain.  Physical examination showed a normal gait without spasm, but there was tenderness.  Provocative hip and sacroiliac joint testing was negative.  Motor, sensory, and reflexes of the lower extremities were normal.  

At the 12 October 2006 VA Compensation and Pension (C&P) examination, 1 week before separation, the CI reported back pain with tenderness and spasms.  The examiner found a “slightly antalgic” gait to the left side from the spine condition, but there was normal spinal contour.  The ROM evaluation showed flexion of 65 degrees and combined ROM of 190 degrees with pain.    

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, coded 5241 (spinal fusion), citing passive ROM limited to 70 degrees by mechanical block.  The VA rated the back condition 20%, dual coded 5242-5243 (degenerative arthritis of the spine-intervertebral disc syndrome), based on the C&P examination, citing moderate pain on motion.  

Spine ratings are based on active ROMs and the PEB cited passive ROMs to justify their 10% rating.  The panel agreed that a 20% rating, but no higher, was justified for limitation of flexion (greater than 30 degrees but not greater than 60 degrees), as reported on the MEB PT ROM evaluation.  Although the ROMs were minimally improved on the VA evaluation, the CI had an antalgic gait specifically attributed to his spine, which with spine tenderness and painful ROM, equated to “guarding severe enough to result in an abnormal gait,” which would alternatively support a 20% rating.  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 recommends a disability rating of 20% for the back condition, coded 5241.  

BOARD FINDINGS:  In the matter of the back condition, the panel recommends a disability rating of 20%, coded 5241 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	5241	20%