RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:XXXXXXXXXXXXXXXX		CASE: PD-2020-00118 BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20060228

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

CI CONTENTION: “Review 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 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 - 20051216	VARD - 20060815	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5299-5242	10%	Chronic Low Back Strain	5243	40%	20060619	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 40%	

ANALYSIS SUMMARY:

Low Back Pain. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s non-traumatic back condition began in 2003. A lumbar spine MRI showed a disc protrusion at L4-5 without stenosis. A repeat MRI in 2005 was unchanged. Although she complained of numbness and tingling in the lower extremities, electrodiagnostic studies were negative.

During the 6 December 2005 MEB NARSUM examination, 3 months prior to separation, the CI reported constant lower back pain at an intensity of 4-6/10. There were no bowel or bladder problems and her back symptoms improved during her recent pregnancy. She also reported numbness and tingling in both legs that caused her some difficulty with ambulation. Physical examination showed tenderness and paralumbar muscle spasms, but there was no evidence of abnormal gait or spinal contour. The range of motion (ROM) showed flexion of 45 degrees (normal 90) and combined ROM of 120 degrees (normal 240), with pain in all planes of motion.

At the 19 June 2006 VA Compensation and Pension (C&P) examination, 4 months after separation, the CI reported weakness, numbness and sharp radiating pain to the buttocks and back of legs. Medication improved the pain. Physical examination showed tenderness and muscle spasms, but the CI had an essentially normal gait and there was no evidence of abnormal spinal contour. Motor strength of the lower and upper extremities was normal (5/5), as was the sensory examination. The ROM study showed 20 degrees of flexion and 75 degrees of combined ROM, with pain in all planes of motion. The examiner noted the ROM was additionally limited due to pain, fatigue and lack of endurance following repetitive use.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the back condition 10%, analogously coded 5299-5242 (degenerative arthritis of the spine), citing tenderness and ROM limited by pain. The VA rated the back condition 40%, coded 5243 (intervertebral disc syndrome), based on the C&P examination, citing limitation of forward flexion of 30 degrees or less. Although the C&P examination supported a rating of 40%, it was performed 4 months after separation and may have included post-separation worsening. Therefore, panel members agreed the pre-separation NARSUM was more proximate to separation and more reflective of the CI’s disability at separation. That examination recorded 45 degrees of flexion and combined ROM of 120 degrees, supporting the 20% rating for “forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees, or combined thoracolumbar spine not greater than 120 degrees.” There was no documentation of intervertebral disc syndrome with incapacitating episodes which would provide for 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 back condition, coded 5299-5242.

BOARD FINDINGS: In the matter of the back condition, the panel recommends a disability rating of 20%, coded 5299-5242 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	5299-5242	20%	

2	PD-2020-00118

DEPARTMENT OF THE ARMY
ARMY REVIEW BOARDS AGENCY 251 18TH STREET SOUTH, SUITE 385
ARLINGTON, VA 22202-3531

AR20200009927

Dear XXXXXXXXXXXXXXX:

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.

Sincerely,

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