RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX 	CASE:  PD-2017-05818
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060122

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Food Service Operation Specialist, medically separated for “chronic low back pain” 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 - 20051121	VARD - 20060605	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5237	10%	Scoliosis of the Thoracolumbar Spine w/ Left Sacroiliac Joint Strain	5299-5239	40%	20060327	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain (LBP).  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s LBP began in July 2003 after an airborne jump, and he underwent physical therapy (PT).  An EMG on 17 May 2005 was normal, and a PT assessment on 23 June 2005 noted full, active thoracolumbar range of motion (ROM), with some pain on end range of flexion, right side bending and right rotation.  The MEB PT ROM evaluation on 21 September 2005, 4 months prior to separation, showed flexion of 65 degrees (normal 90) and combined ROM of 200 degrees (normal 240), after repetition and with pain limiting flexion and left side bending.    
The 5 October 2005 MEB NARSUM examination, 3 months before separation, noted CI complaints of continuous left LBP radiating to the left side, and paresthesia (tingling) into the left leg and foot.  Physical examination showed a non-antalgic gait, slightly decreased thoracolumbar flexion, mild scoliosis and pain with extension.  Iliotibial band testing was positive and there was tenderness over the left greater trochanter, sacroiliac ligaments and left iliolumbar area.  The examiner referenced PT ROM measurements noted above.     

At the 27 March 2006 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported LBP with left leg numbness.   Physical examination showed a normal gait and thoracolumbar forward flexion to 45 degrees, which was reduced to 30 degrees after ten repetitions.  Right and left lateral flexion was 30 degrees (normal), but reduced to 20 degrees after ten repetitions.  Right and left rotation was 30 degrees (normal) with no reduced values reported.  Thoracolumbar ROM was limited by pain, and there was thoracolumbar scoliosis with marked prominence of the left scapular.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, coded 5237 (lumbosacral strain), citing pain limited motion and tenderness.  The VA rated the back condition 40%, analogously coded 5299-5239 (spondylolisthesis or segmental instability), based on the C&P examination, citing scoliosis and left sacroiliac joint strain.   Although the post-separation VA examination demonstrated limitation of flexion to 30 degrees for a 40% rating, the panel placed higher probative value on the service measurements because of the consistency across multiple evaluations.  The panel 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 MEB PT examination.  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 intervertebral disc syndrome 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 LBP. 

BOARD FINDINGS:  In the matter of the chronic low 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.  

XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

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.