RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXX		CASE:  PD-2017-05516
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20060630

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Military Policeman, medically separated for “chronic low back pain, secondary to degenerative disc disease [DDD] and herniated disc L5-S1” with a disability rating of 10%.

CI CONTENTION:  “Degenerative disc disease, herniated disc, bulging disc, secondary insomnia- not rated.”  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 - 20060531 	VARD - 20061214	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain, Secondary to DDD and Herniated Disc L5-S1	5243	10%	Lumbosacral Spine DDD	5243	10%	20061026	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:

Chronic Low Back Pain (LBP).    According to the service treatment record and MEB narrative summary (NARSUM), the CI’s LBP began in 2002 after a motor vehicle accident.  He was treated conservatively and a MEB was initiated, however, he deployed to Iraq for a year.  During the deployment, the back pain gradually worsened with lower extremity pain and numbness, primarily on the left, but at times bilaterally.  The pain was aggravated by physical activity and wearing or carrying military gear.  An MRI on 29 December 2004 showed L5-S1 DDD with a small left disc herniation displacing the left S1 nerve root, but no central spinal canal stenosis.  He declined surgery and conservative treatment did not significantly improve his condition.  

During the 24 March 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 3 months prior to separation, the CI reported LBP and toe numbness and tingling.  Physical examination showed a normal gait and low back and buttocks tenderness.  There was no low back limitation of movement, but painful motion was present.  During the 27 April 2006 MEB physical therapy evaluation, 2 months before separation, repetitive thoracolumbar range of motion (ROM) revealed flexion to 55 degrees (normal 90) and a combined ROM of 170 degrees (normal 240), with pain-limited motion.  The 10 May 2006 MEB NARSUM examination noted complaints of LBP, and the examiner documented lumbar tenderness and referenced the MEB PT ROM findings.

At the 26 October 2006 Compensation and Pension (C&P) general examination, 4 months after separation, the CI reported daily LBP, with sharp pain radiating to the left leg, and 2-3 days of bed rest after each epidural steroid injection during active duty.  The examiner noted normal posture, gait and spinal curvatures, with no spinal tenderness or muscle spasm.  Thoracolumbar ROM showed flexion of 90 degrees and combined ROM of 240 degrees, with painful motion.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back condition 10%, coded 5243 (intervertebral disc syndrome (IVDS)), citing tenderness and pain-limited ROM.  The VA also rated the low back condition 10%, coded 5243, based on the C&P examination, citing painful or limited motion.  Panel members 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 the MEB NARSUM examination, which was most proximate to separation.  There was no evidence of IVDS which resulted in incapacitating episodes requiring physician-prescribed bed rest to warrant a higher rating under that alternate formula.  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 LBP, coded 5243.

BOARD FINDINGS:  In the matter of the low back condition, the panel recommends a disability rating of 20%, coded 5243 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 Low Back Pain, Secondary to Degenerative Disc Disease and Herniated Disc L5-S1	5243	20%	

	PD-2017-05516

XXXXXXXXXXXXXX 

Dear XXXXXXXXXXX

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-2017-05516