RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-05956
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070612

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

CI CONTENTION:  Review requested of all conditions as well as additional conditions not identified by the Medical Evaluation Board (MEB) and 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’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 - 20070501	VARD - 20080917	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5299-5243	10%	Lower Back Strain	5243-5237	10%	20070717	
Chronic Left Foot Pain Secondary to Tarsal Tunnel Syndrome	Not Unfitting	Residuals of Left Foot Fracture	5271	NSC	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain (LBP).  According to the service treatment record and MEB narrative summary (NARSUM), the CI experienced LBP during physical training in January 2006, and an MRI revealed a ruptured disc at L5-S1.  He was treated with chiropractic manipulation, medications and local steroid injections, but due to increasing pain, he underwent a micro-discectomy in July 2006.  His original pain level returned, and a follow-on MRI revealed a small re-rupture at L5-S1, however, a second surgical intervention was not recommended.   During the 15 March 2007 MEB examination (recorded on DD Forms 2807-1 and 2808), 3 months prior to separation, the CI reported extreme back pain with numbness and tingling in both legs.  Physical examination revealed normal lumbar spine flexion and strength.   The 14 April 2007 MEB NARSUM examination noted complaints of LBP with occasional exacerbations due to prolonged standing, walking or cold weather.  He additionally reported occasional radiation of back pain extending down into the legs.  There was no reported history of lower extremity weakness, abnormal bladder or bowel functions.  The PE revealed thoracolumbar flexion to 90 degrees (normal), and a combined range of motion (ROM0 of 225 degrees (normal 240), with pain.  There was  spinal tenderness, but spasm, and lower extremity strength remained normal.  

At the 10 July 2007 VA Compensation and Pension (C&P) examination, 1 month after separation, the CI reported an area of occasional, midline discomfort in the lumbar region.  There was no evidence of gross deformity or spasm, and thoracolumbar ROM measurements showed flexion to 85 degrees with a combined ROM of 190 degrees.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back condition 10%, analogously coded 5299-5243 (intervertebral disc syndrome), citing painful motion and tenderness.  The VA also rated the low back condition 10%, but dual coded 5243-5237 (intervertebral disc syndrome-lumbar spine strain), based on the C&P examination, citing the VASRD criteria for a 10% rating.  Panel members agreed that combined ROM greater than 120 degrees but not greater than 235 degrees, as well as evidence of painful motion IAW §4.59, supported a 10% rating, but no higher.  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:  Chronic Left Foot Pain Secondary to Tarsal Tunnel Syndrome.  The panel’s main charge is to assess the fairness of the PEB determination that the contended condition was not unfitting.  It was not profiled or implicated in the commander’s statement, and did not fail retention standards, and there was no performance-based evidence from the record that it 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 left foot pain, 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 chronic left foot condition, 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.  

AR20190008485, 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.