RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-04956
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080813

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty W2, CH-47 Pilot, medically separated for “chronic low back pain” with a disability rating of 20%.  

CI CONTENTION:  “Mandatory review, but additionally they failed to consider the impact to my quality of life/possible physical activities which were greatly affected despite my range of motion.”  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 - 20080506	VARD - 20090330	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5299-5242	20%	Degenerative Disc Disease Lumbar Spine	5242	10%	20090219	
COMBINED RATING:  20	COMBINED RATING OF ALL VA CONDITIONS:  20% 	

ANALYSIS SUMMARY:  

Chronic Low Back Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI suffered an atraumatic onset of back pain in 2005.  Imaging demonstrated mild diffuse degenerative changes and a small disc protrusion at L5-S1 without neural encroachment.  Multiple STR clinical entries documented normal neurological examinations.  A discogram was equivocal and an electrodiagnostic study was negative.  Surgery was not indicated.  There were multiple STR entries that noted grossly normal range of motion (ROM), with none to the contrary.  There was ample STR documentation of a normal gait.  The majority of entries documented a normal spinal contour, although two later entries, including a final neurology consult, noted an abnormal contour.  

The 30 April 2008 MEB NARSUM examination, 4 months prior to separation, documented “constant” back pain rated 2/10 that was exacerbated by “moderate activity” (profile permitted self-paced running and walking).  The physical examination recorded a normal gait, an abnormal spinal contour (“flattened/reduced lumbar lordosis”), no tenderness, no guarding and no spasm.  The NARSUM cited thoracolumbar ROM measurements from physical therapy six weeks earlier (10 March 2008).  The recorded values significantly exceeded VASRD normals for all planes; and, IAW VASRD 4.71a Note 2, “The normal ROMs for each component of spinal motion provided in this note are the maximum that can be used for calculation of the combined range of motion.”  Consequently, the ratable flexion was 90 degrees (normal) and the ratable combined ROM was 240 degrees (normal), specifying painful motion but no degradation with repetition.  

The 19 February 2009 VA Compensation and Pension (C&P) examination, 6 months after separation, documented persistent non-specific low back pain that was not incapacitating and did not interfere with routine activities or employment.  The physical examination recorded a normal gait and spinal contour, no tenderness and normal neurological findings.  The goniometric ROM study showed flexion of 70 degrees and combined ROM of 210 degrees, specifying “no pain with repetitive motion.”  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 20%, coded 5299-5242 (analogous to degenerative arthritis of the spine), conceding abnormal spinal contour per the neurology consult and NARSUM.  The VA rated the condition 10%, coded 5242, based on the C&P examination, citing the applicable ROM criteria of the VASRD §4.71a spine formula.  There was no limitation of motion or other §4.71a criteria in evidence that would support a rating higher than that of the PEB, supported by the 20% criterion for abnormal spinal contour.  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 back condition.  

BOARD FINDINGS:  In the matter of the 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 there be 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