RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXX	CASE:  PD-2017-04991
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070704

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Multichannel Transmission Systems Operator Maintainer, 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 - 20070521	VARD - 20080401	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5237	10%	Lumbar Strain 	5237	20%	20080303	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain (LBP).  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s back condition began in January 2002 after bad parachute landing fall.  X-rays of the lumbar spine in October 2004 were normal.  He was able to deploy, but complained of intermittent numbness in his right leg.  Post-deployment X-rays in November 2006 showed slight narrowing at L5-S1, but MRI was normal.  The CI was not a surgical candidate.  During the 27 February 2007 orthopedic examination, 4 months prior to separation, the CI reported worsening LBP that radiated into his right leg and foot.  Physical examination revealed a normal gait with normal heel and toe walking and normal posture.  The spine showed no tenderness or spasm, and thoracolumbar range of motion (ROM) was described as “full.”  Pain was not elicited by motion and the neurologic examination was normal.  A bone scan in March 2007 showed was normal.  The 17 April 2007 MEB NARSUM examination, 3 months prior to separation, noted complaints of chronic daily LBP with a severity of 6-7/10 with flares to 9/10 brought on by increased activity or certain positioning.  Physical examination showed tenderness of the back and mild muscle spasms.  The ROM study, after repetition, showed flexion of 80 degrees (normal 90) and combined ROM of 210 degrees (normal 240) with painful motion.  

At the 3 March 2008 VA Compensation and Pension (C&P) examination, 8 months after separation, the CI reported constant LBP rated 8-9/10 with flares to 10/10.  The CI denied any incapacitating episodes.  Physical examination showed a normal gait and posture.  The back was tender and muscle spasm was present.  The ROM study, after repetition, showed flexion of 50 degrees and combined ROM of 155 degrees with painful motion.  Neurologic examination was normal.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, coded 5237 (lumbosacral strain), citing the presence of tenderness and spasm, without deformity, and pain-limited motion.  The VA rated the back condition 20%, coded 5237, based on the C&P examination, citing limitation of motion.

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, which was the most proximate examination to separation.  The panel acknowledged that a 10% rating was also justified for the presence of painful motion, tenderness and muscle spasm.  However, 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.  Panel members noted the VA assigned a 20% rating, but it was based on an examination 8 months after separation where there was no explanation or evidence of an accident, injury or surgery having occurred to account for the decrease in flexion to 50 degrees.   There was no evidence of intervertebral disc syndrome, which resulted in incapacitating episodes requiring physician-prescribed bed rest to warrant consideration of rating under the alternate VASRD formula for that condition.  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 no modification or re-characterization of the CI’s disability and separation determination.  

XXXXXXXXXXXXXXXXXXXX 

Dear XXXXXXXXXXXXXXX

	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