RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXX	CASE:  PD-2017-05255
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20091108

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Health Care Specialist, medically separated for “chronic low back pain” with a disability rating of 10%. 

CI CONTENTION:  “Back pain has remained unchanged.”  Review of additional conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB) was also requested.  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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the 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 - 20090728	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5237	10%	No VA Examination Proximate to Separation in Evidence	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Chronic Low Back Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s back condition began in July 2008 after wearing body armor for longer periods than normal with above average loads.  In January 2009, X-rays (scoliosis survey) revealed 4 degrees of thoracic-lumbar dextroscoliosis.  An MRI in February 2009 was unremarkable and nuclear spin tomography in March 2009 showed degenerative disc disease at L4-5.  

At the 1 June 2009 MEB physical therapy (PT) range of motion (ROM) study, goniometric measurements showed flexion to 70 degrees (normal 90) and combined ROM of 180 degrees (normal 240).  The examiner documented an abnormal spinal contour, tenderness, and pain on extension and left lateral flexion, but no abnormal gait or guarding.  The 15 July 2009 MEB NARSUM examination, 4 months prior to separation, noted CI complaints of intermittent, unpredictable exacerbations of low back pain that precluded wearing battle gear.  Physical examination revealed mild paraspinal pain at L1-2, greater on flexion than extension, with mild spasm, but no humping or overt scoliosis signs.  The examiner referenced the 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 back condition 10%, coded 5237 (lumbosacral strain), citing thoracolumbar forward flexion greater than 60 degrees but not greater than 85 degrees.  Panel members agreed that a 10% rating, but no higher, was justified for limitation of flexion as reported on the MEB PT examination.  Although there was 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 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 chronic 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.  

 
	PD-2017-05255

ARXXXXXXXXXXX, XXXXXXXXXXXXXXXXXXX 

Dear XXXXXXXXXXXXXXXXX

	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

	PD-2017-05255