RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2017-05534
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050301

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

CI CONTENTION:  Review requested of a condition (PTSD with major depression disorder) not identified by the Medical Evaluation Board (MEB) and/or Physical Evaluation Board (PEB).  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 - 20050114	VARD - 20051104	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5237	10%	Degenerative Disk Disease, Lumbosacral Spine	5242	10%	20050711	
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 November 2003 after falling into a trench onto his back.  An MRI showed degenerative disk disease with a perineural parameningeal cyst at L5-S1, and a CT scan also showed a bulging disk at that level.  The CI did not desire surgical intervention.  At a family practice visit on 22 November 2004, 3 months before separation, he complained of chronic LBP with exertion, but was pain-free at rest.  The provider noted low back tenderness, with flexion to 50 degrees (normal 90) and a combined range of motion (ROM) of 150 degrees (normal 240).  The 13 December 2004 MEB NARSUM examination documented low back tenderness, but a normal gait and stance.  Lumbar spine flexion was to 50 degrees and combined ROM was 150 degrees; painful motion was not addressed.  

During the 11 July 2005 VA Compensation and Pension (C&P) spine examination, 4 months after separation, the CI reported a constant, dull low backache that radiated to the left leg during prolonged standing or running, but denied bowel and bladder problems.  Physical examination showed a normal gait with spine and hips aligned, and while there was spinal tenderness, muscle spasm was absent.  Lumbosacral spine flexion ROM was recorded as “140/90 degrees,” extension as “10/30,” lateral extension as “25/30,” and rotation as “30/30,” with painful motion.  An X-ray showed mild degenerative changes.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back condition 10%, coded 5237 (lumbosacral strain), citing tenderness.  The VA also rated the low back condition 10%, but coded 5242 (degenerative arthritis of the spine), based on the C&P examination, citing combined ROM of 210 degrees as well as painful 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 at the family practice and NARSUM examinations.  There was no evidence of intervertebral disk syndrome with incapacitating episodes to support a higher rating under that 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 low back condition, coded 5237.  

BOARD FINDINGS:  In the matter of the low back condition, the panel recommends a disability rating of 20%, coded 5237 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	5237	20%	

The following documentary evidence was considered:

AR20200004260, 

Dear XXXXXXXXXXXXXXXXXXXXX:

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.