RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  pd-2016-00617
BRANCH OF SERVICE:  air force	SEPARATION DATE:  20040719

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E5, Communication/Computer Systems Journeyman, medically separated for “chronic low back pain secondary to degenerative disc disease” with a disability rating of 10%.

CI CONTENTION:  The CI requested a review of 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 - 20040609	VARD - 20050307	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5237	10%	DDD Lumbar Spine S/P Intradiscal Electro thermal Therapy	5243	20%	20041109	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s chronic low back pain condition dated back to 1996.  The back pain was associated with playing sports and initially resolved spontaneously, but eventually required conservative medical treatment.  Eventually the CI was referred to a spine specialist and an IDET (intradiscal electro thermal therapy) procedure was performed in October 1999 at the L5/S1 vertebra level.  The CI then underwent a disability evaluation process which found him fit for duty with a recommendation for retention in a less physically demanding AFSC.  The CI’s back pain returned in 2002 and became more severe in the fall of 2003.  An MRI in December 2003 showed degenerative disc disease (DDD) at the L4/L5 and L5/S1 levels; and postsurgical changes were noted without new disc herniation at L5/S1.  There was no further surgical indication, and conservative treatment did not result in improvement sufficient to allow unrestricted duty.  

The 5 March 2004 MEB NARSUM examination, 4 months prior to separation, noted complaints of more severe back pain (per history above).  The CI had refused physical therapy as he felt this worsened his symptoms.  He was taking over the counter and narcotic medications for the pain, as well as participating in a home physical therapy program and swimming regularly.  Physical examination was based on the 17 December 2003 orthopedic examination.  Range of motion (ROM) showed forward flexion with the CI able to touch his mid shins.  Extension was 15 degrees (30 Normal).  Combined ROM could not be ascertained from this examination; however, painful motion was documented with “twisting” (rotation).  

At the 9 November 2004 VA Compensation and Pension (C&P) evaluation, 4 months after separation, the CI reported a 7 year history of low back pain.  Pain radiated to the legs with an intensity of 7/10.  The CI related incapacitating episodes as often as 3 times per year, which lasted for 1 day each time.  Physical examination showed no complaints of radiating pain on movement.  There was no muscle spasm.  There was tenderness in both SI joints.  ROM measurements showed forward flexion to 45 degrees (90 normal) and combined ROM of 155 degrees (240 normal).  The examiner indicated that ROM was additionally limited by pain, fatigue and lack of endurance, with pain as the major functional impact.  The ROM was not additionally limited by weakness or incoordination.  No ankylosis of the spine was present.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic low back pain condition 10%, coded 5237 (lumbosacral strain) citing DoD and VASRD guidelines.  The VA rated the chronic low back pain condition 20%, coded 5243 (intervertebral disc syndrome), based on the C&P examination 4 months after separation, citing forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 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 C&P examination proximate to separation.  The C&P examination was equally proximate to separation to the NARSUM examination and but was more thorough and detailed using proper goniometric measurements.  Therefore, based on all evidence and the associated conclusions just elaborated, panel consensus was that preponderant probative value should be assigned to the C&P ROM examination.  There was no forward flexion of the thoracolumbar spine 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine, thus the next higher 40% rating was not justified on this basis.  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).  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 low back pain condition, coded 5237.  

BOARD FINDINGS:  In the matter of the chronic low back pain condition, the panel unanimously recommends a disability rating of 20%, coded 5237 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	
Chronic Low Back Pain	5237	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

SAF/MRB

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2016-00617.

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,

Attachment:
1.  Directive 
2.  Record of Proceedings 

cc:
SAF/MRBR