RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX 	CASE:  PD-2017-05748
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090827

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E7, Armor Crewman, medically separated for “chronic low back pain…secondary to invertebral disk syndrome” with a disability rating of 10%.  

CI CONTENTION:  No specific contention was made.  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 - 20090519	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain…	5243	10%	No VA Examination Proximate to Separation in Evidence	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Chronic Back Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s low back condition began in May 2007 with no specific trauma, while deployed to Iraq.  An MRI showed L4-L5 and L5-S1 lumbar disk disease, and an EMG/NCV from January 2008 showed no femoral or peripheral nerve injury.  The orthopedic spine surgeon recommended non-surgical treatment.  During a 5 March 2008 orthopedic evaluation, the CI reported back pain rated at 6/10 and left hip pain.  Physical examination showed a normal appearing lumbosacral spine, no muscle spasms, and no abnormalities during palpitation.  Lumbosacral spine range of motion (ROM) was full, with no painful motion, and no motor dysfunction or sensory abnormalities were noted.  

At the 26 November 2008 orthopedic visit, 9 months before separation, the CI reported increased lower back.  The provider noted tenderness, but no paraspinal muscle spasm or pain elicited by motion.  Flip sign (nerve root tension/irritation) was not exhibited and there was no decreased response to tactile stimulation of the leg/foot or lower extremity weakness.  The surgeon stated non-operative management would be continued.  The CI received a lumbar epidural steroid injection (ESI) at L5-S1 on 12 December that did not provide pain relief.  At the 26 January 2009, orthopedic surgery evaluation, 7 months prior to separation, the CI complained of continued back pain.  Physical examination revealed a normal narrow-based gait and heel and toe walk, and lumbar spine tenderness.   Lumbar ROM was described as “good” and there was no pain with hip ROM.  Motor strength was 5/5 in all extremities and there was normal sensation in all dermatomal distributions.  Straight leg raise (SLR) tests were negative.  An ESI on 4 February reduced the CI’s pain from 7/10 to 3/10 immediately after the procedure. 

During the 9 March 2009 MEB examination (recorded on DD Forms 2807-1 and 2808), 5 months prior to separation, the CI reported recurrent back pain.  Physical examination revealed a normal gait and spinal contour, but tenderness and decreased sensation to the left lateral calf; SLR tests were negative.  At the MEB NARSUM examination the same day, the examiner documented a normal gait, posture and curvature.  There was tenderness with no spasm, and strength and deep tendon reflexes were normal.  There was a mild decreased sensation to the left lateral calf and SLR tests were negative.  Measured ROM showed flexion of 90 degrees (normal) and a combined ROM of 220 degrees (normal 240), with pain.  The 25 March 2009 medical evaluation clinic visit, approximately 5 months prior to the separation, noted CI complaints of chronic lower back pain.  Physical examination showed tenderness and L5-S1 bilateral paraspinal muscle spasms, but no lower extremity weakness or decreased sensation. Deep tendon reflexes were normal and SLR tests negative.  The thoracolumbar spine demonstrated full ROM, and the provider’s plan was to continue with pain management.  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 low back condition 10%, coded 5243 (intervertebral disc syndrome (IVDS)), citing limitation of motion along with a normal gait, strength and deep tendon reflexes.  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.  The panel considered whether a higher rating (§4.7) was achieved by using the alternate rating formula for IVDS, but the CI had no incapacitating episodes requiring physician-prescribed bed rest to warrant consideration of 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 chronic 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.  

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Dear XXXXXXXXXXXXXXXXXX

	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.