RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00626
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20041116

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, F-16 Aircraft Armament Systems technician, medically separated for “low back pain secondary to degenerative disc disease” with a disability rating of 10%.

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 conditions at the time of separation.  The panel has neither the role nor the authority to compensate for progression or complications of service-connected conditions after separation.  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 - 20040820	VARD - 20050503	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Low Back Pain Secondary to Degenerative Disc Disease	5242	10%	Compression, of L5-S1 Disc Space	5299-5242	40%	20050318	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Low Back Pain.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s low back pain condition began in June 2003 during week one of basic training but was not precipitated by any specific trauma.  The CI related a history of back pain prior to enlistment.  At a 12 April 2004 primary care clinic examination, 7 months prior to separation, the CI complained of constant low back pain that was made worse with heavy lifting and bending.  She had no lower extremity weakness but there was leg numbness.  Physical examination showed a normal gait, reflexes, and full range of motion (ROM) of the thoracolumbar spine.  An MRI study in May 2004 showed mild disc bulge at L4-5 with possible herniation and mild degenerative changes at L1-2 and L2-3.  
At the 14 July 2004 Neurosurgery examination, 4 months prior to separation, the CI noted sharp pain that radiated to the back of the thighs and was associated with numbness and tingling.  Physical examination showed the CI with normal strength and reflexes in the lower extremities, with slight diminishment of sensation in the bilateral lower extremities on pinprick sensation testing.  The CI was “able to bend at the waist, touch her toes, and come upright without difficulty.  Extension of her back [was] painful.”  She could walk on her heels and toes without difficulty.  The 27 July 2004 MEB NARSUM examination noted complaints of constant 3/10 back pain that was exacerbated by lifting.  Physical examination showed tenderness and limited ROM.  ROM measurements were not provided.  

At a 9 September 2004 primary care clinic examination, 2 months prior to separation, the CI complained of chronic 10/10 back pain aggravated by long periods of sitting or standing.  The CI reported numbness and tingling in a saddle distribution in her bilateral lower extremities.  Physical examination showed the CI was neurovascularly intact, with normal strength, sensation and reflexes in the lower extremities.  Tenderness was noted at the sacroiliac joint as well as the low back.  The CI was noted to have full ROM.  With flexion she could bend until her finger-tips were less than 10 cm above floor, her extension and bilateral rotation measurements were greater than 40 degrees each (normal 30), and she could laterally bend her fingertips greater than 15 cm down the thigh bilaterally.    

At the 18 March 2005 VA Compensation and Pension (C&P) evaluation, 4 months after separation, the CI reported that she had been seen 6 days prior to this examination in the emergency room due to an exacerbation of her low back pain.  The CI was employed but was restricted from lifting more than 8 pounds at work.  She had missed one week of work as related to the aforementioned low back pain exacerbation.  The CI reported being unable to put on her shoes or socks or shave her legs secondary to limitation of motion of her lower back due to severe back pain.  Physical examination showed a normal posture with antalgic gait.  Muscle spasms were noted.  The CI used no aids for walking.  Thoracolumbar ROM measurements showed flexion of 15 degrees with pain and combined ROM of 155 degrees.  Repetitive ROM testing showed no additional weakness, fatigability, lack of endurance or incoordination. 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back condition 10%, coded 5242 (degenerative arthritis of the spine).  The VA rated the low back condition 40%, analogously coded 5299-5242 (degenerative arthritis of the spine), based on the C&P examination 4 months after separation, citing forward flexion of the thoracolumbar spine to 30 degrees or less.  

In assigning probative value to these somewhat conflicting examinations, the panel noted that the pre-separation primary care clinic ROM measurements were consistent with other proximate (pre-separation) examinations.  Although the VA C&P examination was equally thorough as the PCM examination, the panel believed the findings of muscle spasm, antalgic gait and severely limited forward flexion were post separation worsening or more likely, these physical findings were relative to an acute exacerbation experienced by the CI the week prior to the examination and therefore it is reasonable to assume these findings did not represent the CI’s permanent disability condition with respect to her low back pain.  IAW VASRD §4.7, the panel is obligated to recommend the higher of two ratings where there is a question as to which of two evaluations shall be applied.  The higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating.  Otherwise the lower rating will be assigned.  Physical examination of the CI’s low back condition proximate to separation did not include any neurologic abnormality.  ROM measurements on numerous examinations prior to separation did not indicate the degree of forward flexion limitation as was documented on the VA C&P examination post separation.  Therefore, the panel agreed that preponderant probative value should be assigned to the primary care clinic examination conducted prior to and more proximate to separation.  
Although there was insufficient limitation of motion to support a 10% rating, the panel agreed a 10% rating was justified for the presence of tenderness.  There was no evidence of pre-separation 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.  There was no evidence of in-service 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).  Although the PCM examination did not record goniometric ROM measurements per se, ROM measurements were objectively noted in terms of distance of relative movement.  Based on accepted medical principles, the panel interpreted these relative movement measurements equal to full ROM.  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 low back condition.

BOARD FINDINGS:  In the matter of the low back 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 modification or re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160913, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAF/MRB

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2016-00626.

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,

Attachment:
Record of Proceedings