RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXX	CASE:  PD-2017-05583
BRANCH OF SERVICE:  army	SEPARATION DATE:  20051018

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an E-5, Aircraft Power Plant Repairer, medically separated for “chronic low back pain,” with a disability rating of 10%.  

CI CONTENTION:  Review requested of the back condition, which has worsened.  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 - 20050815	VARD - 20060725	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5243	10%	Lumbar Disc Disease L5-S1 Radiculopathy	5242	20%	20060517*	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20% *	
*Note:  Source document VA examination not in evidence.  VARD and subsequent VARDs used as reference.

ANALYSIS SUMMARY:  

Chronic Low Back Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’S back pain began in February 2004 after standing up from a chair, and MRIs in October 2004 and March 2005 showed a central/left paracentral focal L5 disc protrusion with questionable effect on the intraspinal left S1 nerve root; surgery was not indicated.  At the 15 June 2005 orthopedic visit, 4 months prior to separation, the CI complained of moderate back pain, rated at 6/10, which radiated to the left foot at times.  The pain worsened with prolonged standing, sitting, jumping and sit-ups, but he denied bowel or bladder dysfunction.  Prior treatment included physical therapy (PT), lumbar traction, and epidural/facet injections which provided partial relief.  Physical examination noted a normal appearing lumbosacral spine with no tenderness and negative straight leg raising.  Range of motion (ROM) measurements recorded “lumbosacral” spine flexion to 40 degrees and extension to 20 degrees, with pain noted during rotation.  There was no lower extremity weakness, but numbness was noted in the left thigh.  On 12 July 2005, flight medicine ROM measurements showed back tenderness with increased muscle tone, and flexion to 90 degrees (normal) and combined ROM of 220 degrees (normal 240).  
The 20 July 2005 MEB PT ROM study, 3 months prior to separation, recorded the CI’s chief complaint as low back pain.  “Lumbar” ROM measurements showed forward flexion to 47 degrees and combined ROM of 150 degrees combined with painful motion noted in al planes.  During the 26 July 2005 MEB examination (recorded on DD Forms 2807-1 and 2808), the CI reiterated the history of his back pain, and the MEB NARSUM examination, conducted the same day, also noted complaints of constant, mild baseline pain that was worse when lifting over 20 pounds, wearing battle gear, standing more than 30 minutes, running, and doing sit-ups.   However, the back pain did not interfere with activities of daily living.  Physical examination showed mild bilateral paraspinal tenderness and increased muscle tone in L4-S1 area.  Measured ROM revealed flexion to 90 degree and combined ROM of 220 degrees.  Straight leg raising was negative, although there was increased right-sided pain without radiculopathy.  Reflexes and sensation were normal bilaterally, and lower extremity strength was 4+/5, limited by low back pain.  The CI’s gait and heel-toe walking were normal, but there generalized lumbar tenderness and increased low back pain with cervical loading. The examiner also noted 2 of 5 Waddell's signs (non-organic pain).

According to the 25 July 2006 VA Rating Decision, the 17 May 2006 VA Compensation and Pension (C&P) examination, 7 months after separation, noted CI complaints of continued low back pain with radiation into the left lower extremity.  The pain increased with lifting heavy objects, but there no bowel, bladder or erectile dysfunction, and he did not use any assistive devices to ambulate.  Physical examination revealed difficulty with heel walking, and forward flexion to 36 degrees with combined ROM of 135 degrees, and painful motion noted.  The 14 July 2006 VA C&P neurology examination, 9 months after separation, was focused for complaints of headaches, but the examiner documented a normal gait and station with good heel/toe/tandem walk and normal lower extremity strength, sensation and reflexes.  

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 varying combined ROM limited by pain.  The VA rated the low back condition 20%, coded 5242 (degenerative arthritis of the spine), based on the C&P examination, citing thoracolumbar flexion greater than 30 degrees but not greater than 60 degrees; or combined ROM not greater than 120 degrees.  Panel members noted that the orthopedic and PT examinations referenced (and likely measured) “lumbar” or “lumbosacral” rather than thoracolumbar ROM as specified by the VASRD (§4.71a, Plate V).  The PDBR considered this data and extrapolated the thoracolumbar ROMs based on accepted medical principles to 60 degrees (15 June 2005) and 70 degrees (20 July 2005) of thoracolumbar forward flexion; this also more closely aligned with the flight medicine measurements.  The summarized VA examination was more remote from separation, and thus the panel adjudged that the NARSUM examination (and 12 July 2005 measurements by the same examiner), was closest to separation and had the highest probative value for rating.  Panel members agreed that a 10% rating, but no higher, was justified for limitation of flexion (greater than 60 degrees but not greater than 85 degrees) and/or combined ROM (greater than 120 degrees but not greater than 235 degrees).  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.  

ARXXXXXXXXXXX, XXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXX:

	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.