RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-05808
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050929

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Land Combat Electronic Missile System Repairer, medically separated for “low back pain” with a disability rating of 10%.  

CI CONTENTION:  Review all conditions.  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 - 20050906	VARD - 20060410	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5239	10%	Degenerative Disc Disease, Lumbar Spine	5243	20%	20051230	
Dyslipidemia	Not Unfitting 	No VA Placement	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20% 	

ANALYSIS SUMMARY:  

Chronic Low Back Pain.  According to the MEB narrative summary (NARSUM), the CI experienced low back pain in August 2002, 2 weeks after a motor vehicle accident.  Initial X-rays showed no bony injuries, and despite physical therapy and chiropractic care, he still experienced pain.  A lumbar spine MRI indicated very slight posterior bulges at L4-L5 and L5-S1, and he received an epidural steroid injection which provided 3-4 days of relief.  All methods of care proved unsuccessful; however, CI was not a surgical candidate and he was given a permanent profile.  At an orthopedic evaluation on 29 April 2005, 5 months prior to separation, the examiner noted the CI required no assistance to get up out of a chair.  Gait and posture were normal, and he was able to heel and toe walk.  There was some lumbosacral tenderness, and range of motion (ROM) was “good,” with some pain during extension and flexion.  

The 9 August 2005 MEB NARSUM examination, 1 month before separation, noted complaints of low back pain described pain as "achy" and rated at 5-6/10.  Physical examination revealed no tenderness, spasm, deformity or step-off, and straight leg raise testing was negative bilaterally.  Deep tendon reflexes were +1 and symmetrical.  Goniometrically measured thoracolumbar ROM measurements revealed forward flexion of 78 degrees (normal 90) and combined ROM of 270 degrees (normal 240), after repetition.  No motor or sensory deficits were noted, and the CI exhibited a normal gait and good heel and toe walk.  

At the 30 December 2005 VA Compensation and Pension (C&P) examination, 3 months after separation, the CI reported constant low back pain.  Physical examination of the spine revealed no radiating pain on movement, muscle spasm or tenderness.  Straight leg raising was negative, and there was no ankylosis of the spine.  Thoracolumbar ROM revealed flexion of 60 degrees, with pain, and a combined ROM of 180 degrees, with no additional limitations due to fatigue, weakness, lack of endurance or incoordination following repetitive use.  There were no signs of intervertebral disc syndrome (IVDS) with chronic and permanent nerve root involvement.  Lumbar spine X-rays revealed degenerative arthritis and joint narrowing at L5-S1.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back condition 10%, coded 5239 (spondylolisthesis or segmental instability), citing limitation of motion.  The VA rated the low back condition 20%, coded 5243 (IVDS), based on the C&P examination, citing limitation of forward flexion.  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 as reported on the NARSUM examination, which was most proximate to separation.  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.  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.  

Contended PEB Condition:  Dyslipidemia.  The panel’s main charge is to assess the fairness of the PEB determination that the contended condition was not unfitting.  The contended condition was not profiled or implicated in the commander’s statement, and did not fail retention standards.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition, so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the low back condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended dyslipidemia, the panel recommends no change from the PEB determination as not unfitting.  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, XXXXXXXXXXX 

Dear XXXXXXXXXXX

	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.

Sincerely,					      

Enclosure