RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-04968
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060615

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a National Guard E5, Armor Crewman, 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 - 20060503	VARD - 20070216	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5299-5242	10%	Degenerative Arthritis of the Lumbar Spine	5010-5242	20%	20061113	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s chronic low back pain (LBP) began in April 2004 after lifting and carrying another soldier.  At his initial physical examination (PE), X-rays revealed degenerative changes in the lower lumbar spine.  The CI was treated with anti-inflammatory medication and was cleared for deployment in January 2005.  While deployed, he continued to experience LBP and right leg radiculopathy which was aggravated following a fall from a bunker.  Despite continued conservative treatment, his back pain with radiculopathy continued and he was re-deployed out of theater.  Later, he received local steroid injections that completely resolved his radicular pain, but his back pain remained. 

During the 21 February 2006 MEB NARSUM examination, which was performed 4 months prior to separation and dictated for typing on 10 April 2006, the CI complained of ongoing LBP associated with significant limitation of physical activities.  The 13 March 2006 PT ROM examination, 3 months before separation, revealed thoracolumbar forward flexion of 55 degrees (normal 90) and combined ROM of 145 degrees (normal 240), limited by pain.  The 14 March 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 3 months prior to separation, revealed tenderness, limited ROM and painful ROM.  Straight leg raise testing was negative.  Motor strength was documented as decreased bilaterally due to back pain, but his gait remained normal. 

At the 13 November 2006 VA Compensation and Pension (C&P) examination, 5 months after separation, the CI reported stiffness “all the time” and constant back pain.  No incapacitating episodes were reported.  The functional impairment from his back condition was listed as “difficulty bending over.”  A detailed PE was completely normal including full ROM of the thoracolumbar spine.  Spinal X-rays noted degenerative changes about the lower lumbar spine.  The VA provider documented the spinal examination was unremarkable because the CI took Nortriptyline prior to the examination. 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, analogously coded 5242 (degenerative arthritis of the spine), citing ROM limited by pain and positive tenderness.  The VA rated the back condition 20%, dual coded 5010-5242 (traumatic arthritis-degenerative arthritis of the spine), based on the STR, citing forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees.  The panel majority agreed that a 20% rating, but no higher, was justified for limitation of flexion (greater than 30 degrees but not greater than 60 degrees), as reported on the PT examination.  There was no documentation of intervertebral disc syndrome with incapacitating episodes, which would provide for a higher rating under that formula.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 20% for the back condition, coded 5242.  

BOARD FINDINGS:  In the matter of the back condition, the panel majority recommends a disability rating of 20%, coded 5242 IAW VASRD §4.71a.  The single voter for dissent recommends no change but does not elect to submit a minority opinion.  There are no other conditions within the panel’s scope of review for consideration.  

The panel recommends the CI’s prior determination be modified as follows, effective the date of medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Low Back Pain 	5299-5242	20%	

XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX

The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified to 20% but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	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. 

	A copy of this decision has also been provided to the Department of Veterans Affairs. 

Sincerely,					       
						      					
Enclosure