RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXX	CASE:  PD-2017-05439
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050104

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6 , Attack Helicopter Repairer, medically separated for “chronic subjective low back pain” with a disability rating of 10%.  

CI CONTENTION:  The CI contends her condition has caused her to miss work with the loss of employment due to excessive absences.  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 - 20041101	VARD - 20050425	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Subjective Low Back Pain	5241	10%	L5-S1 Spondylolisthesis 	5243	20%	20041217	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent interbody fusion at L4-S1 in August 2003 for spondylolisthesis with a history of back pain and sciatica.  The 29 September 2004 MEB NARSUM examination, 4 months prior to separation, noted complaints of residual intermittent low back pain.  The CI reported periodic right leg paresthesias after increased activity.  Physical examination showed well healed back incisions.  There were no muscle spasms or lower extremity sensory or motor deficits, and straight leg raise testing (for radicular symptoms) was negative.  Formal physical therapy range of motion (ROM) evaluation on 13 October 2004 showed pain-limited flexion to 40 degrees (normal 90) and combined ROM of 160 degrees (normal 240).  

At the 17 December 2004 VA Compensation and Pension (C&P) examination, 1 month before separation, the CI reported low back pain radiating into the right leg with numbness over the toes.  Physical examination revealed normal posture and gait.  The ROM study showed pain limited flexion of 50 degrees and combined ROM of 170 degrees.  There was no tenderness, spasm, weakness or sensory deficit.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, analogously coded 5241 (spinal fusion), citing limitation of motion.  The VA rated the back condition 20%, analogously coded 5243 (intervertebral disc syndrome), based on the C&P examination, citing forward flexion to 50 degrees.  The panel 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 all examinations proximate to separation.  The criteria for rating diseases and injuries of the spine apply with or without symptoms such as pain (whether or not it radiates), stiffness or aching in the area of the spine affected by residuals of injury or disease.  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 recommends a disability rating of 20% for the back condition, coded 5241.  

BOARD FINDINGS:  In the matter of the back condition, the panel recommends a disability rating of 20%, coded 5241 IAW VASRD §4.71a.  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 Subjective Low Back Pain	5241	20%	

PD-2017-05439

XXXXXXXXXXXXXX

Dear XXXXXXXXXXXX

The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified 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.

	PD-2017-05439