RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00912
BRANCH OF SERVICE:  air force	SEPARATION DATE: 20040903  

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a Reserve E6, Aircraft Structural Mechanic, medically separated for “spondylolisthesis of L5-S1,” with a disability rating of 10%.  

CI CONTENTION:  The back condition is worsening.  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 - 20040617	VARD - 20040302	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Spondylolisthesis of L5-S1	5239	10%	Residuals of Lumbosacral Spine Injury 	5295	10%	20031001	
	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Spondylolisthesis of L5-S1.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s low back condition began in May 2002 as the result of a motorcycle accident.  The CI had a history of grade 1 spondylolisthesis at L5-S1 (where a vertebra steps-off forward of the vertebra below it), noted initially in 1991 or 1992.  As a result of the accident, his back pain increased considerably and he noted urinary dribbling since the injury.  Chiropractic treatment was carried out from 31 May 2002 through 28 August 2002 and resulted in decreased tenderness and spasm with a slight increase in stiffness and occasional pain in his low back.  

At an orthopedic examination on 27 June 2002 the CI was able to get from a sitting to a standing position without difficulty.  He had no list or limp and was able to heel-and-toe walk without any obvious weakness.  There was tenderness in the lower lumbar and lumbosacral area.  Range of motion (ROM) of the lumbosacral spine for flexion was to approximately 75-80 degrees (normal 90), and extension to about 35 degrees (normal 30).  Torsional movements did not seem to produce any pain.  Straight leg raise testing (to determine nerve root irritation) was negative.  Deep reflexes were equal and active in both lower extremities and there was no evidence of any neurologic deficit in either lower extremity.  On 27 June 2002, X-rays of the lumbosacral spine showed a Grade 2 spondylolisthesis of L5 on S1, which almost converted to grade 3 with flexion, with marked narrowing of the intervertebral disc space at L5-S1.  

On 3 September 2002, at the orthopedic surgery visit, there was less tenderness in the lumbosacral spine and straight leg testing was negative.  Surgical intervention was not recommended.  At an orthopedic visit follow-up the CI stated his lower back, which did bother him prior to the motor vehicle accident (MVA) still gave him difficulty; however the examiner noted “he has kind of become accustomed to this discomfort.”  The examiner opined that the pre-existing spondylolisthesis of the lumbosacral area “was probably aggravated by the nature of [the] injuries he sustained in the MVA of 5-24-02.”  On 28 February 2003, at an orthopedic surgery consultation, X-rays from after the injury as well as more recent X-rays showed step-off of about one third of the body and there was no difference between them.  The surgeon noted the CI had spondylolisthesis of L5 on S1 of a moderate degree and the slippage suggested he had a mild cauda equine syndrome.  It was noted, “In either case, neither his pain nor his urinary difficulty [was] sufficiently severe to even consider operative treatment.”  The orthopedic surgeon did not “believe he would be a good risk if he remained in the service, particularly if he were overseas where he might get acute pain at a critical moment.”

At the 1 October 2003 VA Compensation and Pension (C&P) evaluation, 11 months before separation, the CI reported occasional numbness in the lower extremities, with problems standing, climbing ladders, and working overhead.  The CI denied his back giving out.  Physical examination revealed a normal gait and toe to heel walk and negative straight leg tests bilaterally.  ROM testing in degrees was recorded as forward flexion 89, extension 13, right lateral flexion 22 and left lateral flexion 18 (normal for both 30).  Rotation was not noted.

The 1 December 2003 MEB NARSUM examination, 9 months prior to separation, noted complaints of pre-existing spondylolisthesis that deteriorated from Grade 1 to Grade 2 after the MVA.  Though two pages were missing from the NARSUM document, reference was made to orthopedic visits and consultation where physical examination revealed a straight, normal spine with no antalgic gait and no evidence of neurologic deficit in either extremity.  Straight leg tests were negative bilaterally.  Tenderness to the lumbosacral area was noted.  ROM was recorded as “approximately 75-80 degrees flexion and extension of 25-30 degrees.” 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back condition 10%, coded 5239 (spondylolisthesis or segmental instability), citing limitation of motion.  The VA also rated the low back condition 10%, coded 5239, which was crossed out and replaced with the hand-written code 5295 (lumbosacral strain) under the old spine rules,  based on the C&P examination 10 months after separation from active duty, citing limitation of forward flexion.  

The panel agreed a 10% rating, but no higher, was justified for limitation of flexion (greater than 60 degrees but not greater than 85 degrees)  as noted in the C&P examination and referenced in the NARSUM examination based on a prior orthopedic examination before separation.  There was no 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 documentation of intervertebral disc syndrome with incapacitating episodes which would provide for a higher rating under that formula.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the low back condition.

BOARD FINDINGS:  In the matter of the spondylolisthesis of L5-S1 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 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 20160920, with attachments
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-2016-00912.

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