RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2018-00216
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060601

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Signal Support System Specialist, medically separated for “chronic radiating low back pain” with a disability rating of 10%.    

CI CONTENTION:  Review requested of additional conditions not identified by the Medical Evaluation Board (MEB) and/or Physical Evaluation Board (PEB).  

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 PEB - 20060330	VARD - 20070614	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Radiating Low Back Pain	5237	10%	Degenerative Disc Disease, L4-L5 and L5-S1	5243	0%	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0% 	

ANALYSIS SUMMARY:  

Low Back Pain (LBP). According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s back condition began in January 2005 after stepping into a drainage ditch during a run.  An MRI on 4 February 2005 showed degenerative disc disease at L4-L5 with a broad-based bulge or protrusion and mild bilateral foraminal narrowing; and a disc protrusion at L5-S1, which produced a left foraminal compromise.  Neurosurgical evaluation on 22 June 2005 determined the CI was not a surgical candidate, and in the previous 12 months, he had received a total of 6-epidural steroid injections which provided only temporary relief.    

During the 3 January 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 5 months prior to separation the CI reported LBP while transitioning from and during prolonged sitting or standing.  Physical findings showed decreased thoracolumbar range of motion (ROM), but normal heel/toe walking and negative straight leg raising with no neurovascular deficits.  The 4 January 2005 MEB physical therapy (PT) study, the next day, revealed thoracolumbar flexion to 40 degrees (normal 90) and combined ROM of 160 degrees (normal 240), after three repetitions and limited by pain.  The 1 March 2006 MEB NARSUM examination, 3 months before separation, noted CI complaints of constant sharp pain across the lower back, rated at 4/10, which worsened with prolonged walking or bicycling, lifting more than 20 pounds, bending, twisting or doing sit-ups.  The pain improved with lying down or using a lumbar support pillow, and he refused pain medication due to side effects.  He also considered disc replacement surgery, but dismissed this option, which was determined to be a reasonable decision.  Physical examination showed a normal gait, with no neurologic abnormalities, and ROM measurements were cited from the MEB PT examination.  There was no VA examination proximate to separation in evidence.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back condition 10%, coded 5237 (lumbosacral strain), citing tenderness and pain motion limited.  The VA rated the low back condition 0%, coded 5243 (intervertebral disc syndrome (IVDS)) based on the STR, citing the CI had failed to report for a Compensation and Pension examination.  Panel members agreed that a 20% rating, but no higher, was justified for thoracolumbar flexion greater than 30 degrees but not greater than 60 degrees, as reported on the MEB PT ROM examination.  There was no evidence of IVDS resulting in incapacitating episodes and requiring physician-prescribed bed rest to warrant consideration under that alternate 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 low back condition, coded 5237.  

BOARD FINDINGS:  In the matter of the low back condition, the panel recommends a disability rating of 20%, coded 5237 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 Radiating Low Back Pain	5237	20%	

The following documentary evidence was considered:

AR20200004718

Dear XXXXXXXXXXXXXXXXXXXXXXXXXXX:

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.