RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00715
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20040714

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Aerospace Maintenance Journeyman, medically separated for “chronic low back pain” with a disability rating of 10%.   

CI CONTENTION:  “There was more going on than just pain + is degenerative + will/has gotten much worse through the years.”  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 - 20040421	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5237	10%	No VA Examination Proximate to Separation in Evidence	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Chronic Low Back Pain (LBP).  According to the service treatment record (STR) and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s LBP condition began in September 2002 without any specific injury or trauma.  After falling in April 2003, the pain worsened.  In May 2003 MRI studies showed pseudoarthrosis (fracture with nonunion) between the transverse process of L5 and S1 bilaterally and no disc pathology.  There was no surgical indication.  

At the 12 June 2003 orthopedic clinic appointment, 13 months prior to separation, the CI’s gait and back alignment were normal.  Thoracolumbar range of motion (ROM) measurements showed flexion of 40 degrees (normal 90) and combined ROM of 100 degrees (normal 240) with painful motion.  There was diffuse tenderness in the lumbar spine and over the sacroiliac (SI) joints but no muscle spasm.  

The 19 June 2003 physical therapy evaluation, 13 months prior to separation, showed active ROM of the lumbar spine was within normal limits (no measurement were given) and extension caused increased pain.  At the 1 July 2003 family practice evaluation, 12 months prior to separation, physical examination showed full ROM (again, no measurements provided) with increased pain on extension.  The examiner also reported tenderness of the paraspinous muscles.  

The CI attended three pain clinic evaluations from 29 August 2003 to 30 September 2003.  At the 30 September visit, the CI stated he had increased lumbar ROM and his overall pain had decreased.  At each of the pain clinic visits ROM measurements were not addressed; however, the examiner noted that extension, not other movements, aggravated the CI’s back pain.  At each visit he was noted to be in no apparent distress, there was tenderness over the SI joints and muscle spasm was present.  

During the 25 March 2004 MEB NARSUM examination, 4 months prior to separation, the examiner noted the CI had LBP with little relief from treatment.  Physical examination showed no deformity.  There was generalized tenderness and specifically over the right SI joint.  ROM measurements showed flexion of 15 degrees (normal 90); it is unclear if this was the limit of ROM or the point where pain increased.  ROM in other planes was not addressed.  There was no VA examination in evidence proximate to separation.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the LBP condition 10%, coded 5237 (lumbar spine strain).  Panel members noted there was great disparity between exanimations with implications for a rating recommendation.  The panel deliberated the probative value of these conflicting evaluations and carefully reviewed the entire file for corroborating evidence from the period proximate to separation.  Members noted the MEB NARSUM examination only provided forward flexion so the combined ROM could not be calculated, which in and of itself would not render that evaluation to be without value; however, the forward flexion measurement provided varied greatly from other measurements in the record.  Panel members agreed the NARSUM examination would be discounted in determining a disability rating.  

In this case, the LBP and SI joint dysfunction are closely related conditions.  In accordance with VASRD §4.66 (sacroiliac joint), which stipulates, “The lumbosacral and sacroiliac joints should be considered as one anatomical segment for rating purposes,” the panel considered the LBP and sacroiliac dysfunction together for fitness and rating determinations.  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) and combined ROM not greater than 120 degrees), as reported on the orthopedic examination 13 months prior to separation.  There was no reliable evidence of forward flexion limited to less than 30 degrees for the next higher 40% rating.  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 that alternate VASRD formula.  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 LBP condition, dual coded 5236-5242 (sacroiliac injury and weakness – degenerative arthritis of the spine).  

BOARD FINDINGS:  In the matter of the LBP 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 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 LBP	5236-5242	20%	

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
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-2016-00715.

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