RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01111
BRANCH OF SERVICE:  air force	SEPARATION DATE:  20040830

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Security Forces Journeyman, medically separated for “chronic low back pain” with a disability rating of 10%.

CI CONTENTION:  The CI contends that the Physical Evaluation Board (PEB) did not take into account all of the factors associated with her condition including the worsening of it at the time of separation.  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 - 20040521	VARD - 20050331	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5242	10%	Degenerative Disc Disease L4-5, Spondylolisthesis of  L5-S1	5243	10%	20050210	
	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain (LBP).  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s back condition was first noted in 1999, but it significantly worsened in February 2003 without any specific injury or trauma.  Radiographic studies in February 2003 showed degenerative disc disease (DDD) at L4-5 and grade 1/4 spondylolisthesis of L5 on S1 (forward movement of the L5 vertebra on the S1 vertebra), without instability demonstrated on dynamic testing.  Evaluation by neurosurgery concluded that there was no surgical indication.  The 19 February 2004 MEB NARSUM examination, 6 months prior to separation, noted CI complaints of low back pain that was “exacerbated by extended walking, prolonged sitting, prolonged standing, as well as carrying her web gear and A-bag.”  Physical examination showed “good ROM [range of motion] of her low back, but pain with extension.”  There was normal lower extremity motor strength, reflexes, sensation and gait.  Straight leg raise (SLR) testing (for radicular signs) was negative.

At the time of the pain management examination on 3 June 2004, 3 months prior to separation, the CI complained that her pain had gotten worse.  She reported low back pain that radiated to both hips and occasionally down both lower extremities.  She reported that she had pain, graded 5/10, that was “aggravated with prolonged sitting, walking and prolonged standing.”  She also reported that she had “occasional numbness involving both feet effecting both dorsal and plantar aspect of the feet.”  On examination she could flex to 90 degrees (90 normal) and could extend to 20 degrees (30 normal).  There was pain with extension testing.  She had mild spasm, but there was no evidence of an abnormal spinal contour or antalgic gait in the examination.  Lower extremity strength and reflexes were normal and SLR testing caused leg pain bilaterally.  The CI reported also reported “numbness and tingling sensation involving all five toes on the left.”  The pain management specialist indicated the CI should be referred back to neurosurgery for re-evaluation for surgery due to the radiculopathy complaints.  Family practice referred the CI to neurology for evaluation and electrodiagnostic studies in July 2004 after the Formal PEB was completed.  There is no evidence in record that further neurological evaluation took place prior to separation.  

At the 10 February 2005 VA Compensation and Pension (C&P) evaluation, 5 months after separation, the CI reported back pain that radiated to her bilateral buttocks.  She complained of intermittent foot numbness and stated that her feet went numb when she rode the exercise bicycle.  She denied bowel or bladder incontinence.  Physical examination showed a normal gait.  Low back flexion 90, extension, 40 (normal 30), right lateral flexion 30 (normal 30), left lateral flexion 30 (normal 30), right rotation 80 (normal 30), and left rotation 80 (normal 30), with painful motion.  Although she had exaggerated lumbar lordosis, there was no evidence of spasm or guarding.  There was normal lower extremity motor strength, sensation, and SLR testing was negative.  The VA examiner indicated the CI had mild degenerative disc disease, without focal stenosis.  She not had any electrodiagnostic studies performed and there was no evidence on the VA examination of lumbar radiculopathy.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, coded 5242 (degenerative arthritis of the spine), citing extension of 30 degrees and flexion of 90 degrees.  The VA also rated the back condition 10%, coded 5243 (intervertebral disc syndrome), based on the C&P examination 5 months after separation, citing functional limitation due to pain.

The panel agreed that a 10% rating, but no higher, was justified for limitation of flexion (greater than 60 degrees but not greater than 85 degrees) and/or combined ROM (greater than 120 degrees but not greater than 235 degrees), as reported on examinations before separation and also the presence of painful motion, which was evidenced in all of the examinations proximate to separation, both before and after separation.  Although there was muscle spasm noted on the pain management examination, it was not 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 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 that condition.  The panel concluded there was no evidence to support a rating higher than that adjudicated by the PEB.  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 back condition.  

BOARD FINDINGS:  In the matter of the 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 20160920, 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-2016-01111.

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