RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXX	CASE: PD-2017-04906
BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20050127

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

CI CONTENTION: In addition to the back condition, the CI also requested review of the left lower extremity radiculopathy.  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 - 20041209	VARD - 20050628	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic LBP	5299-5237	10%	Degenerative Joint Disease of the Lumbar Spine	5242	40%	20050317	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 50%	
	
ANALYSIS SUMMARY:

Chronic LBP. According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent back surgery in March 2004 with an L5-S1 laminectomy. There was a brief period of reported improvement, but the CI soon began experiencing increased pain. The post- surgical MRI in July 2004 revealed a disc protrusion at L5-S1 and a probable small extruded fragment affecting the L5 root. However, a myelogram showed very minimal effect on the L5 nerve root and so no further surgical intervention was recommended. During the 1 November 2004 MEB examination (recorded on DD Forms 2807-1 and 2808), 3 months prior to separation, the CI reported back pain and numbness to the left leg. Physical examination showed good muscle strength with no atrophy, radicular signs, or neuro deficit. The CI was able to heel-to-toe walk.  Electrodiagnostic studies in November 2004 were normal without any evidence of  lower

extremity radiculopathy. The MEB NARSUM examination nearly 2 weeks later reported LBP. Physical examination showed a normal gait and no muscle atrophy, edema, effusion or neurological deficits. Forward flexion was 80 degrees (normal 90) with a combined range of motion (ROM) of 220 degrees (normal 240).

At the 17 March 2005 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported back pain with pain down the left leg and into the foot. Physical examination showed the CI had an antalgic gait and was using a cane in his right hand. The ROM evaluation showed forward flexion of 30 degrees; however, the CI stopped because of pain. The combined ROM was 90 degrees and it was noted the CI stopped due to pain during extension testing. There was no evidence of fatigue, weakness, or lack of endurance after repetitive motion.  X-rays showed mild osteoarthritis of the lumbar spine.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the back condition 10%, analogously coded 5299-5237 (lumbar spine strain), citing thoracolumbar ROM of 240 degrees. The VA rated the back condition 40%, coded 5242 (degenerative arthritis of the spine), based on the C&P examination, citing forward flexion of the thoracolumbar spine of 30 degrees or less. The panel agreed that a 10% rating, but no higher, was justified for limitation of flexion (greater than 60 degrees but not greater than 85 degrees) and combined ROM (greater than 120 degrees but not greater than 235 degrees), as reported on the NARSUM examination. 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 intervertebral disc syndrome with incapacitating episodes which would provide for a higher rating under that formula. The panel discussed the significantly worsened limitation of motion at the VA C&P examination and agreed that refusal to attempt thoracolumbar spine excursion to full painful limits does not meet an acceptable standard for a ratable measurement. While the CI may have experienced radiating pain from the back condition, this is subsumed under the general spine rating criteria, which specifically states “with or without symptoms such as pain (whether or not it radiates).” 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 low back condition 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.

PD-2017-04906

XXXXXXXXXXXXXXXXXXXX 

Dear XXXXXXXXXXXXXXXX

	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

PD-2017-04906