RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:XXXXXXXXXXXXXXXXXXXXX	CASE: PD-2017-05190
BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20051210

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

CI  CONTENTION:	“Exam  was  not  thorough  and  details  were  overlooked.”	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 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 - 20051024	VARD - 20060525	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Mechanical LBP	5299-5237	10%	Degenerative Disc Disease L4- L5 and L5-S1	5243-5242	0%	20060117	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 30%	

ANALYSIS SUMMARY:

LBP. According to the service treatment record and MEB narrative summary (NARSUM), the CI’s back condition began insidiously in September 2003. An MRI on 8 March 2005 was unremarkable. X-rays on 7 June 2005 revealed mild anterior wedging at T12 and L1. Despite chiropractic care and physical therapy, the CI had no significant improvement. At a clinic visit on 23 February 2005, he indicated that the LBP was related to moving equipment. A 4 April 2005 note indicated the CI was not a candidate for neurosurgery. X-rays dated 7 June 2005 showed mild anterior wedging T12 and L1 vertebral bodies of concern for a fracture of an unknown duration.

A 22 June 2005 family practice clinic visit noted an MRI which showed degenerative joint disease consistent with age, but no severe arthritis or herniation. At a rheumatology clinic visit one week later, the CI indicated the back pain was constant, but waxed and waned in severity. On examination there was mild tenderness with mild pain on flexion. The examiner noted there was a nonspecific elevation of the ANA (a test for connective tissue disease) with no objective

evidence of a systemic autoimmune disorder. The rheumatologist indicated the CI’s backache was most likely mechanical LBP and regional myofascial pain syndrome involving the left trapezius. Treatment consisted of a muscle relaxer.

The 12 August 2005 MEB NARSUM examination, 4 months prior to separation, noted the complaint of chronic LBP. Physical examination showed tenderness in the lumbar area. Heel and toe walking was intact. Thoracolumbar range of motion (ROM) for flexion was 90 degrees (normal) and combined ROM of 220 degrees (normal 240).

At the 17 January 2006 VA Compensation and Pension (C&P) examination, one month after separation, the CI reported LBP associated with lifting three to four times a week. Physical examination noted he walked without a limp and had no difficulty rising from a chair or changing position on the examination table. Lumbar flexion was 90 degrees and combined ROM was 240 degrees. There was no tenderness or spasms and spinal contour was normal.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the back condition 10%, analogously coded 5299-5237 (lumbosacral strain), citing thoracolumbar ROM greater than 240 degrees with localized tenderness. The VA rated the back condition 0%, analogously coded 5243-5242 (intervertebral disc syndrome [IVDS]), based on the C&P examination, citing forward flexion of the thoracolumbar spine greater than 85 degrees; or, combined ROM greater than 235 degrees.

The panel agreed a 10% rating, but no higher, was justified for combined ROM (greater than 120 degrees but not greater than 235 degrees) as reported on the NARSUM examination. 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. There was no documentation of IVDS 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 low back condition.

BOARD FINDINGS: In the matter of the low 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.

2	PD-2017-05190

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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.