RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01559
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20040309

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

CI CONTENTION:  The CI requests 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 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 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.  Furthermore, the panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The panel’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 panel 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 panel 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 - 20031023	VARD - 20050804	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic LBP	5295	10%	Chronic Lumbosacral Strain with Degenerative Changes	5237	20%	20041124	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Chronic LBP.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s low back condition began in October 2001 after pulling chains out of storage on the flight line.  A 7 March 2002 lumbar spine magnetic resonance imaging (MRI) study showed a small disc bulge and minimal disc protrusion at the L5-S1 level with no significant foraminal (nerve root opening) or spinal stenosis (narrowing).  

At the 10 June 2002 pain management encounter, the CI complained of intermittent, stabbing, 2-5/10 LBP with radiation to the posterolateral aspect of the right leg to the foot.  He reported occasional pain radiating down the left leg and associated foot numbness (L>R).  Pain was exacerbated by sitting and Valsalva maneuvers (forceful expiration with a closed glottis) and relieved by lying down.  The CI was taking no medications.  The physical examination documented a normal gait.  The back examination revealed no lumbar tenderness and no abnormal lumbar or thoracic spinal contour.  The examiner stated “flexion of the back is at 30 degrees when the patient complains of pain.”  The bilateral straight leg raise (SLR) tests (assess for herniated disc causing sciatic nerve root [L5-S1] radiculopathy) were positive.  Muscle tone, strength, and sensation were normal and deep tendon reflexes (DTRs) were 2+ at the left knee and 1 + at the right knee and bilateral ankles.  The examiner recounted the findings of the MRI.  The CI received 2 L4-L5 epidural steroid injections (ESIs) with corticosteroid and local anesthetic in July and August 2002.  The ESIs alleviated the pain for a short period of time, but the discomfort returned after both injections.  

The 21 July 2003 MEB NARSUM examination 8 months prior to separation, noted complaints of increased pain after lifting “anything.”  He reported increasing pain radiating to the left lower extremity, but was able to ambulate normally with only an occasional limp.  The CI denied incontinence.  Neurosurgery did not recommend surgery.  The back examination documented “decreased range of motion with tenderness to palpation over the L5-S1 area.”  The bilateral SLR tests were negative.  At a 1 October 2003 physical therapy (PT) appointment, the CI complained of 1-3/10 LBP.  The physical examination documented lumbar spine ROM revealed “slight stiffness in all directions.”  The SLR and Patrick (assesses hip and sacroiliac joint pathology) tests were negative.  Sensation and DTRs were normal and trunk flexion/extension strength was 4-4+/5.  

The 24 November 2004 VA Compensation and Pension (C&P) examination, 9 months after separation, recounted the history and interventions.  The CI stated “low back pain is felt all the time and is felt in the lower back and the buttocks and does not radiate down either lower limb.”  Because of LBP, the CI reported he had missed 2 days of work as a civilian airport baggage inspector since September 2004.  The LBP seriously interfered with the CI’s ability to run, jog, lift, and bend.  The physical examination documented a slow normal gait.  The low back examination revealed tenderness to percussion and impaired ROM.  The spine ROM values were flexion of 35 (90 normal), extension of 10 (30), and bilateral rotation of 35 (30) degrees.  The ROM was not additionally limited by pain, fatigue, weakness, or lack of endurance with repetition.  “The neuromuscular function is normal.”  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back condition 10%, coded 5295 (lumbosacral strain), citing LBP.  The VA rated the chronic lumbosacral strain condition 20% coded 5237 (lumbosacral strain), based on the C&P examination 9 months after separation, citing forward flexion limited to 35 degrees.  The panel agreed that a 20% rating, but no higher, was justified for limitation of flexion (greater than 30 degrees but not greater than 60 degrees) reported on the VA C&P examination.  There was no associated radiculopathy for separate peripheral nerve rating.  While the CI may have experienced radiating pain from the back condition, this is subsumed under the general spine rating criteria, which specifically states “with or without symptoms such as pain (whether or not it radiates).”  There was no objective evidence of a radiculopathy with functional impairment (such as weakness) that directly impacted fitness for duty.  The panel therefore concluded that an additional disability rating was not justified on this basis.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 20% for the chronic LBP condition, coded 5237.  

BOARD FINDINGS:  In the matter of the LBP condition, the panel unanimously recommends a disability rating of 20%, coded 5237 IAW VASRD §4.71a.  There were no other conditions within the panel’s scope of review for consideration.  

The panel 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 LBP	5237	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150625, 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

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2015-01559.

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,

XXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
1.  Directive 
2.  Record of Proceedings