RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXX	CASE: PD-2017-06006
BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20061130

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

CI CONTENTION:  Review of 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 - 20061012	VARD - 20070619	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5243	10%	Degenerative Disc Disease, Lumbar Spine	5242	0%	20070509	
Enuresis	Not Unfitting	Nocturnal Enuresis	7542	NSC	20070503	
Mallory-Weiss Tear	Not Unfitting	GERD Status Post Mallory Weis Tear	7346	0%	20070425	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 30%	
	
ANALYSIS SUMMARY:

Chronic Low Back Pain. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s back condition began in February 2000 while playing basketball. Conventional treatment was rendered for years until the back pain began to radiate into the left leg in January 2006. MRI studies revealed a disc herniation at L5-S1 with mild-to-moderate narrowing of the exiting nerves. During an orthopedic examination on 8 March 2006, 9 months prior to separation, the CI reported left low back pain extending into the buttocks and left leg to the calf.   Physical examination showed no spinal tenderness.        Range of motion testing, after

repetitive motion, showed flexion of 45 degrees (normal 90), but all remaining ROMs were considered “full.” Painful motion was not addressed. At the 10 July 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 5 months prior to separation, back flexion was 70 degrees with pain. No other ROMs were addressed. At the 10 July 2006 MEB NARSUM examination, the CI reported continued low back pain. Physical examination showed no gait deficit, but spinal tenderness was present. The ROM study showed flexion of 90 degrees and combined ROM of 210 degrees (normal 240) with pain.

At the 9 May 2007 VA Compensation and Pension (C&P) examination, 5 months after separation, the CI reported low back pain, stiffness and spams with pain extension into his left leg. Physical examination revealed a normal gait and posture. Thoracolumbar flexion was 90 degrees and combined ROM was 240 degrees without pain.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the back condition 10%, coded 5243 (intervertebral disc syndrome (IVDS)), citing painful flexion. The VA rated the back condition 0%, coded 5242 (degenerative arthritis of the spine), based on the C&P examination, citing a noncompensable examination. 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 recorded on the preponderance of STR ROM examinations proximate to separation. Although the VA C&P ROM examination supports a 0% rating, the panel determined that this examination was an outlier. Additionally, there was no muscle spasm or guarding severe enough to result in an abnormal gait or spinal contour, nor was there IVDS with incapacitating episodes to support a higher rating. 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 back condition.

Contended PEB Conditions: Enuresis and Mallory-Weiss Tear. The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting. The Mallory-Weiss tear was not profiled, implicated in the commander’s statement or failed retention standards. There was no performance-based evidence from the record that this condition significantly interfered with satisfactory duty performance at separation. The panel noted that the enuresis was a condition not constituting a physical disability IAW DoDI 1332.38 E5.1.3.9.1. Therefore the panel has no reasonable basis for recommending this condition as additionally unfitting. After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determinations for either of the contended conditions, so no additional disability ratings are recommended.

BOARD FINDINGS: In the matter of the back condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication. In the matter of the contended enuresis and Mallory-Weiss tear, 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. Therefore, the panel recommends no modification or re-characterization of the CI’s disability and separation determination.

PD-2017-06006

XXXXXXXXXXXXXX 

Dear XXXXXXXXXXXX

	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.

PD-2017-06006