RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01456
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20050411

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Fire Protection Apprentice, medically separated for “chronic low back pain,” 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 - 20050204	VARD - 20050915	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5237	10%	Lumbar Stain with Bilateral Spondylosis Defects at L5	5237	0%	20050825	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain (LBP).  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s LBP condition began in February 2004 after heavy lifting.  The MEB forwarded “LBP, chronic” for PEB adjudication.  

A radiographic (X-ray) study done on 7 December 2004, 4 months prior to separation, showed a Schmorl node (an upward and downward protrusion (pushing into) of a spinal disc’s soft tissue into the bony tissue of the adjacent vertebrae) and some soft tissue calcifications.  The MEB NARSUM examination on the same day noted complaints of significant back pain.  The CI had functional limitations of an inability to perform his duties.  The range of motion (ROM) examinations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.  

Thoracolumbar ROM
(Degrees)	MEB~4 Mos. Pre-Sep	VA ~5 Mos. Post-Sep	
Flexion (90 Normal)	Restricted forward flexion	90	
Combined (240)	-	240	
Comments	 tender left paraspinal area; straight leg raise 45 degrees on left; reflexes, motor, sensory nml; mildly stiff gait;	Tenderness upper to lower lumbar area; painful motion; Deluca neg; gait nml;	
§4.71a Rating	10%	 10% (VA 0%)	

At the 25 August 2005 VA Compensation and Pension (C&P) evaluation, performed approximately 5 months after separation, the CI reported constant daily moderate back pain rated 5/10 with flares two to three times weekly lasting 2-3 days.  He was taking a hydrocodone/acetaminophen twice once daily though it was prescribed twice daily.   He used no assistive devices and could walk for several miles.  He was working as a stocker at Home Depot and the pain was not restrictive.  He also was able to mountain bike.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic LBP condition 10%, coded 5237 (lumbosacral strain).  The VA rated the lumbar stain with bilateral spondylosis defects at L5 condition 0% coded 5237, based on the VA C&P examination approximately 5 months after separation, citing the combined ROM of greater than 235 degrees.  Although there was insufficient limitation of motion to support a minimum rating, the Board agreed a 10% rating was justified for the presence of tenderness.  There was no muscle spasm or guarding severe enough to result in an abnormal gait or spinal contour, thus the next higher 20% rating was not justified on this basis.  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 LBP condition.  

BOARD FINDINGS:  In the matter of the chronic LBP condition and IAW VASRD §4.71a, the Board unanimously 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 20150612, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2015-01456.

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,

						
XXXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings