RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2017-05978
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070111

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a National Guard E6, Unit Supply Specialist, medically separated for “back pain” with a disability rating of 0%.  

CI CONTENTION:  In addition to the continued pain from the unfitting back and not unfitting headaches and wrist pain, the CI requested review of additional conditions not identified by the Medical Evaluation Board (MEB) and/or 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 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 FPEB - 20061130	VARD – 20080509	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Back Pain 	5241	0%	Degenerative Disc Disease Lumbosacral Spine; Status Post Lumbar Spine Fusion	5243	10%	20080123	
Headaches	Not Unfitting	Headaches	8100	0%	20080123	
Carpal Tunnel Syndrome	Not Unfitting	Carpal Tunnel Syndrome	8515	0%	20080123	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  20% 	

ANALYSIS SUMMARY:  

Chronic Back Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s back condition began in September 1999 after normal duties at her unit.  An MRI was done of her lower back.  She was referred to a neurosurgeon and had her first surgery after she was noted to have bulging discs with pinched nerves.  For the first few years post-op she did better.  Before surgery, her pain level was up to a 10.  After surgery, her pain improved to a level 2.  In 2004 her pain returned, and it was sharp and shooting down her legs.  She developed muscle spasms in her mid-back.  The CI had a repeat surgery in 2005 with no improvement in her pain.  

The 23 February 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 11 months prior to separation, recorded thoracolumbar range of motion (ROM) forward flexion of 80 degrees (normal 90).  Straight leg raise was normal to 90 degrees bilaterally.  Motor examination and gait were normal.  The thoracolumbar spine revealed lordosis; however, scoliosis, gross deformities, tenderness, and muscle spasm were not noted.  The 12 June 2006 physical therapy examination, 7 months prior to separation, noted thoracolumbar flexion of 50 degrees and pain at rest prior to motion.  The MEB NARSUM examination 2 weeks later noted complaints of back pain.  The physical examination was completed during the MEB examination cited above.

At the 23 January 2008 VA Compensation and Pension (C&P) examination, 12 months after separation, the CI reported back pain that was 4-5/10 and flared to 7 with prolonged activities.  Physical examination revealed thoracolumbar ROM forward flexion of 90 degrees (normal 90) and combined ROM of 225 degrees with pain.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 0%, analogously coded 5241 (spinal fusion), citing thoracolumbar range of motion limited by pain and a normal gait.  The VA rated the back condition 10%, analogously coded 5243 (intervertebral disc syndrome), based on the C&P examination, citing painful motion with a combined ROM of the thoracolumbar spine at 225 degrees.  A 20% rating, but no higher, was justified for limitation of flexion (greater than 30 degrees but not greater than 60 degrees), as reported on the PT examination proximate to separation.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 20% for the back condition, coded 5241.  

Contended PEB Condition:  Headaches and Carpal Tunnel.  The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting.  Neither of the conditions were profiled, implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that either of the conditions 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 any of the contended conditions, so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the chronic back pain, the panel recommends a disability rating of 20%, coded 5241 IAW VASRD §4.71a.  In the matter of the contended headaches and carpal tunnel conditions, the panel recommends no change from the PEB determinations as not unfitting.  There are no other conditions within the panel’s scope of review for consideration.  

The panel recommends the CI’s prior determination be modified as follows, effective the date of medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Back Pain 	5241	20%	

The following documentary evidence was considered:

AR20200004049

Dear XXXXXXXXXXXXXXXX:

The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	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. 

	A copy of this decision has also been provided to the Department of Veterans Affairs.