RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00204
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20080422

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Integrated Avionics System Journeyman, medically separated for “chronic low back pain,” with a disability rating of 20%.

CI CONTENTION:  The CI contends he was given a higher rating for his conditions by the VA and was not properly evaluated for all conditions while in the Service.  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 - 20080304	VARD - 20081020	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5237	20%	Chronic Lumbar Strain	5237	10%	20080825	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain.  According to service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s non-radicular back pain began in October 2006 without any injury or trauma.   Lumbar spine X-rays completed on 14 February 2007 were noted to be normal.  He was treated conservatively.  At the MEB NARSUM examination on 3 October 2007, 7 months prior to separation, the CI reported his back pain was not resolving and he was not able to perform his military duties without exacerbating his back pain.  The NARSUM examiner referred to the physical examination completed in August 2007 which showed a normal gait and stance, normal movement of all extremities, no tenderness to palpation, no motor weakness, and normal strength, sensory and reflexes.  The provider recommended a pain specialist consult, but the CI declined any further specialty care or consultations.  Thoracolumbar range of motion (ROM) measurements performed by physical therapy (PT) on 7 November 2007 showed active flexion to 50 degrees (normal 90), extension 25 degrees (normal 30), right lateral flexion 30 degrees (normal 30), left lateral flexion 20 degrees (normal 30), right rotation 30 degrees (normal 30), left rotation 30 degrees (normal 30) after repetitive motion.  The CI denied radicular pain or paresthesia.  His gait was normal.   

At the 25 August 2008 VA Compensation and Pension (C&P) evaluation, performed 4 months after separation, the CI reported constant low back pain, described as burning, aching, sharp, sticking and cramping, rating the pain at a 7/10.  The CI denied any incapacitation.  Physical examination showed a normal gait and posture.  Tenderness was noted.  There was no evidence of radiating pain on movement and no muscle spasm.  Straight leg raise testing was normal bilaterally.  ROM measurements showed flexion of 80 degrees (normal 90) and combined ROM of 220 degrees (normal 240) with painful motion.  The spine function was not additionally limited by pain, fatigue, weakness, lack of endurance or incoordination after repetitive use.   

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 20%, coded 5237 (lumbar spine strain), citing forward flexion of 50 degrees.  The VA rated the back condition 10% coded 5237, based on the VA C&P examination 4 months after separation citing forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 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 NARSUM/PT examinations.  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 concluded that there was insufficient cause to recommend a change in the PEB adjudication for the lumbar spine condition.  

BOARD FINDINGS:  In the matter of the lumbar spine condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  There are no other conditions within the panel’s scope of review for consideration.  The panel, 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 20160408, 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-2016-00204.

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