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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.

RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-05065
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20080606

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a National Guard E3, Trainee, medically separated for “chronic low back pain” with a disability rating of 10%.  

CI CONTENTION:  The condition continues to worsen and negatively affects daily activities.  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 - 20080519	VARD - 20090327	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5299-5243	10%	Degenerative Disc Disease, Lumbar Spine	5242	20%	20090227	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Low Back Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s back condition began insidiously in October 2007 during physical training.  An MRI documented multi-level lumbar degenerative disc disease and X-rays revealed lumbar spine levoscoliosis, but surgical treatment was not an option.  

At the physical therapy (PT) evaluation on 1 February 2008, 4 months prior to separation, the CI was using crutches and displayed a deviated gate pattern.  Goniometric range of motion (ROM) measurements were normal in all planes, except she lacked 5 degrees of extension, and there was painful motion.  There was no additional functional impairment on repetition.  The 14 March 2008 MEB NARSUM examination, 3 months prior to separation, noted complaints of intermittent low back pain which worsened throughout the day.  The pain level would elevate to 7/10.  The examiner referenced the above PT examination and noted there was no tenderness or muscle spasms.  The examiner opined that the CI would lose 5-10 degrees of forward flexion of her back during flares.  

At the 27 February 2009 VA Compensation and Pension (C&P) examination, 8 months after separation, the CI reported lower back pain radiating to the left leg.  Physical examination showed normal posture and gait.  Thoracolumbar ROM measurements, after repetition, were flexion of 90 degrees (normal) and combined ROM of 240 degrees (normal), with painful motion.  There was no muscle spasm or guarding severe enough to result in an abnormal gait or spinal contour.  X-rays showed lumbar spine levoscoliosis.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, analogously coded 5243 (intervertebral disc syndrome), citing flexion of 95 degrees with 10 degrees lost on repeated use.  The VA rated the back condition 20%, analogously coded 5242 (degenerative arthritis of the spine), based on the C&P examination, citing the 20% rating criteria.  All examinations proximate to separation documented painful motion supporting a 10% rating IAW VASRD §4.59, but there was insufficient limitation of motion to support a 20% rating.  Although there was an abnormal spinal contour (levoscoliosis), it was not attributable to muscle spasm or guarding.  Therefore, 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.  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.