RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME: XXXXXXXXXXXXXXXXX	CASE: PD-2017-04365
BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20050630

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was a Reserve E5, Food Service 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 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 - 20050411	VARD - 20060327	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5243	10%	Lumbosacral Strain, Myositis and Spondylosis L4-L5 Disc Herniation Lumbosacral Discogenic Disease	5243	40%	20050910	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 40%	

ANALYSIS SUMMARY:

Chronic Low Back Pain (LBP). According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s LBP condition began in 2003 while performing physical fitness training. A lumbar spine MRI taken in June 2004 revealed an L4-L5 disc bulge and L5-S1 disc desiccation (disc dehydration). The CI’s condition was treated conservatively without surgical intervention.

The 15 November 2004 MEB NARSUM examination, 8 months prior to separation, noted complaints of constant LBP and that the C required a cane to walk. He denied bowel or bladder dysfunctions. Physical examination revealed low spine tenderness. Thoracolumbar flexion was 45 degrees (normal 90) and combined range of motion (ROM) was 135 degrees (normal 240). Painful motion was not addressed. The 17 November 2004 MEB NARSUM addendum recorded back flexion to 45 degrees and combined ROM was incomplete.  Painful motion was elicited.

At the 10 September 2005 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported continued LBP that extended into his tailbone and left leg. Physical examination noted the use of a cane to walk, gait steady, and a back brace was used for support. The spinal contour was normal and spinal tenderness was present. Thoracolumbar spinal flexion was 50 degrees and combined ROM was 140 degrees with painful motion present. There was 10 degrees of flexion (which equates to a functional loss of 40 degrees) following repetitive motion due to pain (DeLuca testing).

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the LBP condition 10%, coded 5243 (intervertebral disc syndrome (IVDS)), citing limitation of flexion. The VA rated the LBP condition at 40%, also coded 5243, based on the C&P examination, citing limitation of flexion. The panel agreed that a 20% rating, but no higher, was justified for limitation of spinal flexion (greater than 30 degrees but not greater than 60 degrees), as reported on the MEB NARSUM and addendum examinations. Although the VA ROM examination supports a 40% rating, the preponderance of STR evidence does not support this higher rating. There was no evidence of IVDS with incapacitating episodes to support a higher rating under that formula. 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 LBP condition, coded 5243.

BOARD FINDINGS: In the matter of the low back condition, the panel recommends a disability rating of 20% coded 5243 IAW VASRD §4.71a. 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 Low Back Pain	5243	20%	

2	PD-2017-04365

AR20200002319, 

Dear XXXXXXXXXXXXXX

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.