RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02142
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20060111

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Personnel Journeyman, medically separated for “chronic back pain,” with a disability rating of 0%.

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 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 - 20051129	VARD - 20060526	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Back Pain	5237	0%	Lower Back Condition	5237	NSC	20060313	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Chronic Back Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s low back condition began in September 2000 after falling on ice.  Leading up to the MEB, the CI’s back pain continued with aggravation during periods of prolonged sitting, standing and physical activities.  Numerous range of motion (ROM) examinations leading up to the MEB process showed the CI had near normal forward flexion (normal 90 degrees).  At a 6 June 2005 family practice examination performed 7 months prior to separation, the CI complained of variable 0-3/10 pain with recurring flares up to 10/10.  Physical therapy had been helping.  At a 28 June 2005 physical therapy appointment performed 6 months prior to separation, the CI complained of ongoing low back pain for 5 years.  Examination showed his back had a forward flexion of 85 degrees (normal 90) and an extension of 15 degrees (normal 30) with mild tenderness to his lower back in the S1 area.  At a 6 July 2005 physical therapy appointment performed 6 months prior to separation, the CI complained of minimal improvement since his last appointment and his pain was a 7/10.  Examination showed he had full ROM.  A Magnetic resonance imaging (MRI) study in August 2005, showed degenerative disc findings in L4-5 and L5-S1 without canal stenosis or disc protrusion.  There was no surgical indication.  

The MEB NARSUM examination on 13 September 2005 (4 months prior to separation) noted complaints of persistent back pain despite several years of conservative treatment and physical therapy.  Physical examination showed mild lumbar tenderness with normal strength sensation.  ROM was “essentially full with only mild limitations in flexion consistent with pain.”  At a 25 October 2005 physical therapy examination performed 2 months prior to separation, the back ROM measured, using an incline-goniometer, flexion of 20 degrees (normal 90).  

At the 13 March 2006 VA Compensation and Pension (C&P) evaluation, performed 2 months after separation, the CI reported sharp, cramping pain with an intensity level of 7/10.  The pain was elicited by physical activity or it could come on by itself.  Examination revealed normal posture and gait, normal ROM without pain, no muscle spasm and no weakness.  Provocative maneuvers for signs of radiculopathy or radiating pain due to spinal nerve root or sciatic nerve involvement were negative.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back pain condition 0%, coded 5237 (lumbosacral strain).  The VA did not service connect the lower back condition, but coded it 5237, based on the C&P examination 2 months  after separation, citing the condition was acute and transitory with no residuals shown.  There was no limitation of thoracolumbar spine motion to support a minimum rating under the General Rating Formula for Diseases and Injuries of the Spine, however the 13 September 2005 physical therapy examination noted the presence of painful motion.  A 10% rating was therefore warranted.  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.  The panel did note the significantly diminished ROM as reported in the 25 October 2005 physical therapy appointment, but the panel agreed this measurement was not consistent with the entirety of the CI’s record and the preponderance of the STR evidence did not portray the back condition at that severity level.  There was no documentation of intervertebral disc syndrome (IVDS) with incapacitating episodes which would provide for a higher rating under that formula (for IVDS).  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 chronic back pain condition, coded 5237.  

Contended PEB Conditions:  Obesity.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  Obesity is a condition not constituting a physical disability, IAW DoDI 1332.38; therefore, the panel has no basis for recommending it as unfitting.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the chronic back pain condition, the panel unanimously recommends a disability rating of 10%, coded 5237 IAW VASRD §4.71a.  In the matter of the contended obesity condition, the panel unanimously recommends no change from the PEB determination as not unfitting and not compensable or ratable.  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 Back Pain	5237	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150708, 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-2015-02142.

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.  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:
Record of Proceedings