RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01353
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20040706

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Contracting Craftsman, medically separated for “chronic low back pain (LBP) associated with degenerative disk 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 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 (VA), 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 - 20050506	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic LBP	5242	10%	Disc Bulges at L4-5 and L5-S1, Lumbosacral Spine	5243	NSC	20050310	
	COMBINED RATING OF ALL VA CONDITIONS:  0% 	

ANALYSIS SUMMARY:  

Chronic LBP.  According to the service treatment record and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s LBP condition began in January 2001 without specific injury or trauma.  A 23 October 2003 MRI revealed mild diffuse disc bulge at L4-L5 and degenerative joint disease at L5-S1.  The CI was treated conservatively with muscle relaxant and anti-inflammatory medications.  

At a neurological examination on 4 February 2004, 5 months prior to separation, the CI had chronic LBP twice a month lasting 2-3 days each episode.  The CI denied radicular pain, weakness, numbness, and gait disturbance.  The physical examination was normal.  The examiner opined musculoskeletal LBP and recommended continue symptomatic therapy.  
The 4 March 2004 MEB NARSUM examination, 4 months prior to separation, noted complaints of episodes of chronic, LBP with intermittent muscle spasms.  The pain was exacerbated by sitting and standing.  The physical examination showed a normal gait and full range of motion (ROM).  There was mild tenderness in the paraspinous muscle and along the vertebral bodies at the lower thoracic and lumbar spine.  

At the 10 March 2005 VA Compensation and Pension (C&P) evaluation, 8 months after separation, the CI reported intermittent lumbosacral spine pain with muscle tightness.  She reported use of a muscle relaxant.  The physical examination showed normal lordosis and gait. ROM testing was not performed; however, the examiner noted the spine was not painful and there was no evidence of spasms.  During a 12 September 2005 C&P evaluation, 14 months after separation, the CI reported flare-ups of back pain precipitated by performing daily activities or any kind of exercise either of which led to bedrest for several days.  The physical examination showed a forward flexion of 60 degrees (normal 90), extension to 10 degrees (normal 30), lateral rotation to 20 degrees bilaterally (normal 30), and normal lateral flexion to 30 degrees bilaterally (normal).  There was evidence of lumbosacral painful motion and tenderness, but no evidence of muscle spasms.  Gait and lordotic curve were normal.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the LBP condition 10%, coded 5242 (degenerative arthritis of the spine).  The VA did not initially service-connect the LBP condition during the original disability claim.  However, a follow-on decision review rated the LBP 20%, coded 5243 (intervertebral disc syndrome), based on the C&P examination 14 months after separation, citing painful motion and potential functional loss due to muscle spasm and flare-ups.  

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 reported on the NARSUM examination proximate to 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.  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 LBP condition.  

BOARD FINDINGS:  In the matter of the LBP 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.  Therefore, the panel recommends 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 20160921, 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-2016-01353.

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.  Accordingly, the Board recommended no re-characterization or modification of your separation.

I have 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.  Accordingly, I accept their recommendation that your application be denied.

Sincerely,

Attachment:
Record of Proceedings