RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02048
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20070611

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Signals Intel Analyst, medically for “mechanical low back pain” with a disability rating of 0%.  

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 PEB, but determined 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.  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 determination 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(s) 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 - 20070413	VARD - 20080424	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Mechanical Low Back Pain	5299-5237	0%	Degenerative Disc Disease, Lumbar Spine, L1-L2, L2-L3 and L3-L4 with Subjective Complaint of Pain radiating Through the Pelvis Down the Right Leg to the Knee	5242	10%	20080220	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Mechanical Low Back Pain.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s mechanical low back pain condition began in August 2006 after running.  The CI denied any specific injury or trauma.  She reported upper lumbar pain that did not radiate and was without neurological symptoms.  At the time of the primary care appointment on 19 January 2007, the physical examination showed a normal gait and stance.  There was full range of motion (ROM) of the thoracolumbar spine, with pain during movement for both flexion and extension.  There was tenderness to palpation in the lower back, without muscle spasms.  Lower extremity strength, sensation, and reflexes were normal and examination maneuvers to elicit radicular symptoms were negative.  Magnetic resonance imaging of the spine was performed on 14 December 2006 and at the neurosurgical consult on 30 January 2007 degenerative disc disease of the thoracolumbar spine was diagnosed.  Core strengthening exercises were recommended, but the neurosurgeon recommended it was best if the CI separated from the military and sought sedentary work.  A primary visit on 5 February 2007 again showed full ROM of the thoracolumbar spine, but with painful motion noted.  The 20 February 2007 MEB NARSUM examination, 4 months prior to separation, noted complaints of daily low back pain aggravated by activities such as running or carrying a backpack.  The physical examination showed a normal gait.  There was no tenderness to palpation over the spine.  Lower extremity strength and sensation was normal, and straight leg raise testing to elicit radicular symptoms was negative.  The ROM was described as “L-spine range of motion” with flexion 35 degrees (normal 90) and combined ROM 175 degrees (normal 240).

At the 20 February 2008 VA Compensation and Pension (C&P) evaluation, 8 months after separation, the CI reported low back pain with radiation to the knee, aggravated by activity with weekly flare-ups lasting a day.  The physical examination showed normal contours of the thoracolumbar spine.  The CI exhibited tenderness to touch over the lower spine.  Back ROM was flexion 80 degrees and combined ROM 180 degrees, with painful motion.  There was no additional loss of ROM with repetitive motion.  Lower extremity strength and reflexes were normal and SLR was negative.  Lumbar spine X-rays showed degenerative disc disease.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back pain condition 0%, coded 5299-5237 (lumbosacral strain), citing DoDI guidelines.  The VA rated the low back pain condition 10% coded 5242 (degenerative arthritis of the spine), based on the C&P examination 10 months after separation, citing limitation of forward flexion of the thoracolumbar spine.  

The panel noted that the limitation of flexion (35 degrees) recorded in the MEB NARSUM examination potentially met the threshold for a 20% rating.  The ROM values as recorded by the MEB examiner were not consistent with the objective absence of spasm, tenderness or abnormal contour which were documented in the same examination.  Additionally, the examiner specified lumbar spine and it was therefore unclear to the panel if this value represented isolated lumbar ROM or combined thoracolumbar ROM as required in the VASRD.  Lumbar ROM is generally taken to be 60 degrees and therefore 35 degrees combined with otherwise normal thoracic ROM would equate to combined thoracolumbar ROM of approximately 65 degrees.  There was no STR documentation of significant ROM limitation prior to the MEB, and several examinations documented normal ROM.  The post-separation VA examination also noted mildly decreased TL ROM of 80 degrees.  Panel members agreed that the MEB recorded flexion ROM was in marked contrast to all other evidence, and that, even if the ROM was accurately measured and reflected combined TL ROM at that examination, the panel's permanent rating recommendation should be representative of the overall disability picture based on consideration of all examinations proximate to separation.  Therefore, based on the total evidence in record and IAW VASRD §4.7 (higher of two evaluations), which states that when there is a question between two evaluations, whichever criteria the disability picture more nearly approximates will be assigned.  Therefore, the panel recommends a 10% rating.  There was no documentation of intervertebral disc syndrome (IVDS) with incapacitating episodes which would provide for a higher rating under that formula for IVDS, or evidence of ratable peripheral nerve impairment which would provide for additional rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Panel recommends a disability rating of 10% for the mechanical low back pain condition, coded 5243.  

BOARD FINDINGS:  In the matter of the mechanical low back pain condition, the panel unanimously recommends a disability rating of 10% coded 5243 IAW VASRD §4.71a.  There are 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	
Mechanical Low Back Pain	5299-5237	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150603, 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-2015-02048.

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.  The Board recommended modification of your assigned disability rating without re-characterization of your separation with severance pay. 

I 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.  This will not result in any change to your separation documents or the amount of severance pay you are entitled to.  Disability severance pay is computed the same regardless of a rating of 0, 10 or 20 percent.

Sincerely,

XXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
1.  Directive 
2.  Record of Proceedings 

cc:
SAF/MRBR