RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01381
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20030415

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

CI CONTENTION:  The CI requested a review of all conditions.  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 on 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 - 20030226	VARD - 20031020	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain (Mechanical)…	5295	10%	Mechanical Low Back Pain	5237	0%	20030714	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:

Chronic Low Back Pain (Mechanical).  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s low back condition began in March 2002 after a motor vehicle accident.  The pain improved and she returned to duty which included wearing a web belt and carrying an M-16.  The standing for long periods and wearing full gear made the pain worse.   X-rays of the lumbral-sacral spine were normal.  Conservative therapy did not improve the pain.  The MEB forwarded “mechanical low back pain” for PEB adjudication.  The MEB NARSUM examination on 8 December 2002, 5 months prior to separation, noted complaints of continued low back pain without radicular signs.  Neurosurgery noted mechanical low back pain and recommended cross training.   Medications included an anti-inflammatory agent twice daily and a mild narcotic agent on occasion.  Restrictions included no lifting greater than 20 pounds, no web belt, no prolonged standing or walking.  Physical examination showed the back with full range of motion (ROM), negative straight leg raise, normal lower extremity sensation, 5/5 strength in lower extremity, normal gait and deep tendon reflexes.  

At the 14 July 2003 VA Compensation and Pension (C&P) evaluation, performed 3 months after separation, the CI reported back pain with exacerbation with bending, twisting, heavy lifting, sitting/standing for long periods of time and without lower extremity paresthesias, bowel/bladder dysfunction, decreased muscle strength or gait disturbance.   She could perform daily routine activities and was not employed.  Physical exam showed normal gait and posture, equal leg length, and no signs of abnormal weight bearing.  She did not require an assistive device to walk.  There was radiating pain on movement with absent muscle spasm and tenderness.  There was negative straight leg raising bilaterally and no signs of radiculopathy.  Measured ROM was normal and not additionally limited by pain, fatigue, weakness, lack of endurance or incoordination.   No diagnosis was rendered regarding the back condition because no pathology was observed.  

The Board directed attention to its rating recommendation based on the above evidence. The PEB rated the low back condition 10%, coded 5295 (Lumbosacral strain), citing a condition as not compatible with rigors of military service as evidenced by extreme restrictions.  The VA rated the low back condition 0% coded 5237 (lumbosacral strain), based on the VA C&P examination 3 months after separation, citing full ROM with no limitation due to pain or other abnormalities.  X-ray was normal.  The VASRD coding and rating standards for the spine, which were in effect at the time of separation, were modified on 23 September 2002 and then changed to the current §4.71a rating standards on 26 September 2003.    The separation date of April 2003 resulted in the PEB rating the low back condition according to the old spine rules. The VA rated the condition according to the new spine rules that specify rating thresholds in degrees of ROM impairment.  The older standards for rating based on ROM impairment were subject to the rater’s opinion regarding degree of severity, hence the PEB rating of 10% for pain on motion.   There was no evidence of muscle spasm on flexion, loss of lateral spine motion, unilateral, in standing position to assign a higher rating of 20%.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the chronic low back pain condition.  

BOARD FINDINGS:  In the matter of the chronic low back pain condition and IAW VASRD §4.71a, the Board recommends no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration.  The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150610, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAF/MRB

XXXXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2015-01381.

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 appropriate.  Accordingly, the Board recommended no re-characterization or modification of your separation.

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  Accordingly, I accept their recommendation that your application be denied.

Sincerely,

Attachment:
Record of Proceedings