RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-04872
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20061121

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a Reserve E5, Motor Transport Operator, medically separated for “chronic low back pain” with a disability rating of 10%.  

CI CONTENTION:  No specific contention was made.  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 - 20061025	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5243	10%	No VA Examination Proximate to Separation in Evidence	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Chronic Low Back Pain (LBP).  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s LBP began in August 2002 with no specific onset and worsened in August 2005 during a deployment.  Treatment consisted of physical therapy through the deployment, which allowed him to perform duties.  At a primary care appointment in January 2006, the CI complained of LBP and the provider documented full, active, thoracolumbar range of motion (ROM) with muscle spasms but no tenderness.  An MRI showed some multilevel degenerative changes of the lumbar spine and an epidural steroid injection in February 2006 provided some temporary relief, but the CI elected not to repeat treatment.  He also underwent a CT myelogram, which did not reveal any nerve root impingement.  Surgery was not recommended and non-operative management, including oral medication and physical therapy (PT), was ineffective.  

During the 23 August 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 3 months before separation, the CI reported recurrent back pain.  Physical examination revealed L4-5 and S1 tenderness and painful ROM with flexion of 85 degrees (normal 90) and combined ROM of 210 degrees (normal 240).  The MEB NARSUM examination the same day noted complaints of chronic daily and persistent LBP, especially with bending, stooping, and squatting.  Sitting for long periods did not bother him with frequent posture changes, but he could not stand more than 20 minutes, run, or do unrestricted walking or other activities.  Physical examination showed a mildly antalgic gait, normal heel-to-toe walk, and positive straight leg raising at 80 degrees bilaterally.  During the PT evaluation on 6 September 2006, 2 months prior to separation, the CI reported LBP rated at 5/10.  Physical examination recorded normal gait and ROM with flexion of 50 degrees and a combined ROM of 170 degrees after repetition.  The examiner opined the CI had reached maximum PT benefit.  There was no VA examination proximate to separation in evidence.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the LBP 10%, coded 5243 (intervertebral disc syndrome), citing positive tenderness and forward flexion of 85 degrees.  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), as reported on the MEB NARSUM examination.  The panel discussed the probative value of the 6 September 2006 PT measurement, but agreed it was an outlier with no changes in the STR that indicated a worsening of the condition.  The preponderance of the evidence did not show 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 incapacitating episodes due to intervertebral disc syndrome for a higher rating under that formula.  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 LBP.  

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