RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02376
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20080501

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an Air National Guard E4, Ground Radio Journeyman, medically separated for “chronic low back pain due to degenerative disc disease (DDD) and Sacroiliitis” with a disability rating of 20%.  

CI CONTENTION:  The CI made no specific contention.  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 - 20080318	VARD - 20081126	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic LBP due to DDD…	5243	20%	Facet Joint Arthritis, L-Spine…	5236-5242	40%	20081113	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain due to Degenerative Disc Disease and Sacroiliitis.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s back condition began in December 2001 after falling.  

At the time of the 16 August 2007 orthopedic clinic appointment, 9 months prior to separation, the examiner recorded that the CI was able to sit, stand and walk throughout her workday without limitations or restrictions, but would be unable to tolerate the wear of protective and personal gear weighing 40 pounds.  On examination, ROM was recorded as flexion to 35 degrees (normal 90) with no combined ROM recorded.  There were no other examination findings.  The 21 September 2007 MEB NARSUM, 7 months prior to separation, noted complaints of chronic low back pain and indicated the same ROMs as the above orthopedic evaluation.  The 8 January 2008 NARSUM addendum, 4 months prior to separation, indicated that the CI’s medical condition had not changed.  

At the 26 November 2008 VA Compensation and Pension (C&P) evaluation, 7 months after separation, the CI reported that her back pain was aggravated by prolonged standing, bending with twisting, and lifting.  She also reported flare-ups that occurred annually and caused her pain level to rise to 9 or 10 out of 10 on the pain scale with “increased weakness, fatigability, and loss of coordination.”  Physical examination showed ROM recorded as flexion to 40 degrees and combined ROM as 170 degrees (normal 240).  The examiner indicated that the CI was only able to tolerate two flexion measurements secondary to pain and spasm, but did not indicate any additional limitation of motion during the examination.  However, the examiner opined that the CI would have an additional loss of approximately 5 to 10 degrees of ROM during painful flare-up episodes.  The examiner also noted that the CI had “protective motions” and spasm, but her spinal alignment was normal and she could walk on her heels and toes (the examiner did not comment on the CI’s gait).  There was also tenderness to palpable and a mild pocket of swelling noted in the lumbosacral joint space.  Although the CI had a positive straight leg raise on the right (for radicular symptoms), her motor strength, sensation, and reflexes were normal.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 20%, coded 5243 (intervertebral disc syndrome).  The VA rated the back condition 40% coded 5236-5242 (sacroiliac injury and weakness with degenerative arthritis of the spine, based on the VA C&P examination 6 months after separation, citing flexion limited to 40 degrees with an additional 10 degrees loss during flare-ups.  

Members agreed that the orthopedic and MEB examinations were more consistent with outpatient notes and more reflective of the anticipated severity based on the clinical pathology.  The panel therefore relied more heavily on the orthopedic and MEB measurements, and placed less probative value on the post-separation C&P examination.  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.  There was no evidence of intervertebral disc syndrome (IVDS) which resulted in incapacitating episodes requiring physician-prescribed bed rest to warrant consideration of rating under the alternate VASRD formula (for IVDS).  There was no evidence of an associated unfitting radiculopathy for consideration of a separate peripheral nerve rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the back condition.  

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

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150824, 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-2015-02376.

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.  The Board recommended no re-characterization or modification of your separation.

I 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.  I accept their recommendation that your application be denied.

Sincerely,

XXXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings