RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-04967
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050722

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

CI CONTENTION:  “Severe disc loss and broad-based disc bulge.”  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 - 20040708	VARD - 20050924	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Mechanical Low Back Pain	5299-5242	10%	Degenerative Disc Disease, Lumbar 	5243	20%	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Chronic Mechanical Low Back Pain.  According to the service treatment record (STR) and  MEB narrative summary (NARSUM), the CI’s back condition began in February 2002 without any specific injury or trauma, and he was seen in the emergency room on multiple occasions for lumbar spasms.  In July 2004, X-rays showed loss of L5-S-1 intervertebral disk space height, and MRI in August 2004 showed a disc protrusion at L5-S1.  An STR entry in January 2005 recorded bilateral paraspinal spasms, but they were not associated with abnormal gait or spinal contour. 

The 27 January 2005 neurology examination noted CI complaints of fluctuating back pain that occasionally radiated down the left lower extremity to the knee, but he denied weakness or numbness.  The provider noted a normal gait and the ability to heel-to-toe walk without difficulty.  The range of motion (ROM) evaluation noted decreased forward flexion (fingertips to mid-tibia, approximately 65-80 degrees), decreased extension to just past neutral, and lateral bending and rotation decreased to approximately half of the normal ROM.  There was pain in all planes of movement.  Strength and reflexes were normal, but sensation of the entire left lower extremity was decreased to light touch; electro diagnostic studies were negative for radiculopathy.  

At the 21 March 2005 MEB physical therapy (PT) ROM evaluation on 21 March 2005, 4 months prior to separation, the CI complained of back pain rated at 4-5/10 that radiated into the left groin region.  On examination, active ROM measurements showed lumbar flexion of 60 degrees (normal 90) and combined ROM of 150 degrees (normal 240), limited by pain.  The examiner used an inclinometer to measure forward flexion, extension and lateral flexion, and a goniometer to measure rotation.  During the 16 June 2005 MEB NARSUM examination, 1 month before separation, the examiner noted that the CI was still able to perform his military specialty duties with some limitations, but could no longer fulfill the requirements of being a soldier.  Physical examination showed a non-antalgic gait and the ability to heel-to-toe walk.  Muscle strength and reflexes were normal, and the examiner quoted the MEB PT ROM measurements.  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 low back condition 10%, coded 5299-5242 (analogous to degenerative arthritis of the spine), citing thoracolumbar forward flexion limited to 70 degrees.  The VA rated the back condition 20%, coded 5243 (intervertebral disc syndrome (IVDS)), based on the STR, citing limitation of forward flexion.  The panel noted the MEB PT ROM study was conducted with a non-VASRD compliant inclinometer.  However, the panel agreed that a 10% rating, but no higher, was justified for painful motion (§4.59) associated with functional loss.  Although there was a history of muscle spasm, it was not 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 evidence of IVDS which resulted in incapacitating episodes requiring physician-prescribed bed rest to warrant consideration of rating under that formula.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the back condition.   

BOARD FINDINGS:  In the matter of the chronic mechanical 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