RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00050
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20060512

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

CI CONTENTION:  His condition should have been rated higher.  The CI’s complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited 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 PEB, but determined to be not unfitting.  Any conditions outside the Board’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.  Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations is based upon a review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation.  The Board 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, operating under a different set of laws.  The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20060322	VARD - 20060822	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5237	10%	L4-5 Disc Bulge with Impingement, Chronic Pain, and Radiculopathy	5243	20%	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Low Back Pain.  According to service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s LBP condition began in December 2004.  The CI denied any specific injury or trauma.  Diagnostic imaging studies on 27 June 2005 revealed bulging intervertebral discs at L4-5 level without neural compression.  Surgical intervention was not indicated.  Despite conservative treatment, to include epidural steroid injections, his painful condition did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “chronic back pain,” for PEB adjudication.  

At the MEB NARSUM examination on 26 January 2006, 3 months prior to separation, the CI reported LBP extending to the right side and aggravated by heavy lifting.  His physical examination (PE) revealed a normal gait and posture.  Low back tenderness was present. Thoracolumbar range of motion (ROM) was performed on 01 March 2006, 2 months prior to separation, and was globally decreased with flexion of 50 degrees (normal is 90) and a combined ROM of 140 degrees (normal is 240).  There was no VA Compensation and Pension (C&P) examination contained in the case file due to the CI’s failure to report for a scheduled evaluation on 14 August 2006.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back condition 10%, coded 5237 (lumbar spine strain).  The VA rated the back condition at 20%, coded 5243 (intervertebral disc syndrome), based on the STR, citing limited forward flexion.  All Board members agreed that a 20% rating, but no higher, was justified for limitation of forward flexion to 50 degrees near the time of separation as documented on the MEB NARSUM examination.  The Board also considered if additional disability rating was justified for peripheral nerve impairment due to a radiculopathy.  Members concluded that the PE’s proximate to separation revealed no objective findings of radiculopathy that would impact duty performance or be described as functionally impairing.  Therefore, no additional disability rating was justified on this basis.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 20% for the chronic LBP condition, coded 5237.  

BOARD FINDINGS:  In the matter of the low back condition, the Board unanimously recommends a disability rating of 20%, coded 5237 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.  The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Low Back Pain	5237	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150120, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAF/MR
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD  20762

Dear XXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2015-00050.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was not appropriate under the guidelines of the Veterans Affairs Schedule for Rating Disabilities.  Accordingly, the Board recommended modification of your assigned disability rating without re-characterization of your separation with severance pay.

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding, accept their recommendation and direct that your records be corrected as set forth in the attached copy of a Memorandum for the Chief of Staff, United States Air Force.  The office responsible for making the correction will inform you when your records have been changed.

Sincerely,

Attachment:
1.  Directive 
2.  Record of Proceedings 

cc:
SAF/MRBR