RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-04865
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20071127

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6, Combat Documentation Specialist, medically separated  for “chronic low back pain” with a disability rating of 20%.  

CI CONTENTION:  “The rating is inaccurate because I have been diagnosed with more than was stated in the board and my condition has worsened.”  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 - 20070809	VARD - 20080320	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5243	20%	Lumbar Intervertebral Disc Degeneration…	5243	20%	20080118	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

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 March 2006 when he noted numbness and tingling in his legs after running.  An MRI on 4 April 2006 showed multilevel degenerative disc disease and arthropathy compounded by a congenital spinal stenosis.  He underwent an L4 laminectomy on 12 June 2006 but subsequently reported worsened LBP, with right lower extremity pain and numbness.  A repeat MRI showed synovial (joint lining) cysts at L4-5 and the CI underwent a second surgery for revision and fusion at L5-S1 on 7 September 2006.  Following the second surgery, the lower extremity symptoms improved, but his LBP continued.  
The 28 March 2007 MEB NARSUM examination, 8 months prior to separation, noted complaints of LBP and stiffness, without neurological symptoms.  Physical examination showed an antalgic gait favoring the right, however, the CI could heel and toe walk without difficulty and had no radiation of pain with movement.  Range of motion (ROM) was “severely” limited with flexion of 30 degrees and combined ROM of 150 degrees.  Lumbar spine imaging in October 2006 and January 2007 noted normal lumbar curvature with no instability.  Further elective surgery for spinal fusion was discussed, but the CI chose not to have any further surgery.  

During the 2 May 2007 MEB examination (recorded on DD Forms 2807-1 and 2808), 7 months prior to separation, the CI reported LBP and back arthritis, and that he was unable bend down or  sit, stand, or kneel for prolonged periods.  Physical examination showed tenderness, mild muscle spasm, and decreased ROM.  Physical therapy measured ROM for the MEB on 20 June 2007, and flexion was 25 degrees and combined ROM was 75 degrees.  The therapist noted the CI had an abnormal gait due to muscle spasm and all limitation of motion was due to pain.  

At the 18 January 2008 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported persistent LBP without radiation but denied flare-ups or incapacitation.  He was not under treatment, did not use a back brace, and took pain medication as needed.  On physical examination, he walked with a limp and used a cane.  There was a midline vertical scar on the low back without postural abnormality or fixed deformity, and no tenderness or muscle spasm.  Low back ROM was flexion of 40 degrees and combined ROM of 170 degrees.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back condition 20%, coded 5243 (intervertebral disc syndrome), citing abnormal gait due to muscle spasm and ROM limited by muscle spasm.  The VA also rated the low back condition 20%, coded 5243, based on the C&P examination, citing forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or, combined ROM not greater than 120 degrees.  Members noted that the ROM measurements at the MEB NARSUM and PT examinations support a 40% rating, however, the evidence at the C&P examination warrants a 20% rating.  At the time of the PT evaluation, the therapist documented the presence of muscle spasm, which would explain why the ROM was so limited.  The C&P examination was the most proximate to separation and provided evidence after the longest period of recuperation following the second back surgery.  Therefore, the panel assigned it greater probative value for a rating recommendation and concluded that the MEB PT ROM evaluation did not reflect permanent limitation of motion and was also consistent with a 20% rating for an abnormal gait due to muscle spasm.  Members agreed that a 20% rating, but no higher, was justified for limitation of flexion and/or combined ROM as reported on the VA examination.  There was no evidence of intervertebral disc syndrome which resulted in incapacitating episodes requiring physician-prescribed bed rest to warrant consideration of rating under the alternate VASRD formula for that condition.  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 low back condition.  

BOARD FINDINGS:  In the matter of the chronic 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.  

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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.

Sincerely,					      
Enclosure