RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00022
BRANCH OF SERVICE:  AIR fORCE	SEPARATION DATE:  20041102

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Diagnostic Imaging Craftsman, medically separated  for “chronic lower 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 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 - 20040805	VARD - 20051229	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Lower Back Pain…	5243	10%	Degenerative Disc Disease (DDD), Lumbar Spine	5242	40%	20051119	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:  

Chronic Lower Back Pain (LBP).  According to the service treatment record and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s back condition began in January 2003 after moving equipment at work and feeling a spasm in his lower back.  He was seen in family practice and treated with a non-steroidal anti-inflammatory drug.  His LBP steadily worsened, and he began to experience pain radiating into his right buttock and right lower extremity to just above the knee.  He subsequently had numerous visits to family practice, referrals to physical therapy, and two emergency room visits.  A February 2003 MRI showed a diffuse disc bulge with central prominence at L4-5 and central-left paracentral disc protrusion at L5-S1. 
Another MRI in November 2003 showed degenerative disc changes, and the CI was referred to pain management and neurosurgery.  Neurosurgery determined that he had mechanical LBP, mild right quad weakness, and degenerative L4, L5 and S1 discs with associated bulge.  He was advised to continue with pain management but return for further evaluation if the pain persisted.  In January 2004, the CI began right-sided epidural corticosteroid injections (ESI) at L4-L5 and L5-S1 as well as facet injections, which yielded some improvement. However, the CI also began to report left lower extremity symptoms similar to the right extremity.  

The undated MEB NARSUM examination, showed an intact gait, full range of motion (ROM), and minimal lower lumbar tenderness with no tension.  No cyanosis, clubbing, or edema was present and straight leg raise testing was negative bilaterally.   Motor and sensory functions were normal, and deep tendon reflexes were 2+/4 at the Achilles and ~1+/4 at the patella.  

The 14 September 2005 pain management examination, 10 months after separation, indicated a 2½-year history of low back and bilateral leg pain.  Physical examination showed an antalgic gait with mild to moderate distress due to pain.  The lumbar spine was tender on both sides, straight leg raise testing was positive on the right side, and pain was noted as aggravated by hyperextension and lateral bending.  Deep tendon reflexes were equal and symmetric.  There was no loss of motor sensory function and ROM was not reported.  

The 13 October 2005 physical medicine examination, 11 months after separation, indicated that the CI’s symptoms had decreased following ESI treatment.  Physical examination showed a normal gait and full ROM.  A re-evaluation on 20 October 2005 documented an antalgic gait and back flexion limited to 40 degrees (normal 90).  

At the 19 November 2005 VA Compensation and Pension (C&P) evaluation, 12 months after separation, the CI reported daily back pain radiating to his buttock and upper posterior thigh which limited his ability to lift greater than 5 pounds.  He denied incapacitating episodes and bowel or bladder dysfunction, but endorsed weekly flares caused by twisting or lifting.  Physical examination showed no fixed flexion deformity or spasm, however, there was mild tenderness along the paraspinous muscles down to the buttock.  ROM tests showed forward flexion to 26 degrees (normal 90) and a combined ROM at 135 degrees (normal 240).  Forward flexion was reduced to 18 degrees before significant pain began limiting movement.  Repetitive motion caused immediate onset of pain.  Lower extremity motor strength was 5/5 bilaterally, reflexes were 2+, and sensation was normal.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic LBP condition 10%, coded 5243 (intervertebral disc syndrome).  The VA rated the lumbar spine DDD condition 40%, coded 5242 (degenerative arthritis of the spine), based on the C&P examination 12 months after separation, citing forward flexion of 30 degrees or less.  The panel agreed that the NARSUM examination was closest to separation, best reflected the totality of the record, and had the highest probative value for rating at separation.  There was no limitation of thoracolumbar spine motion to support a 10% rating under the General Rating Formula for Diseases and Injuries of the Spine; however the NARSUM and the preponderance of the record noted the presence of painful motion and/or localized tenderness, and so a 10% rating was therefore warranted.  There was no documentation of intervertebral disc syndrome which resulted in incapacitating episodes requiring physician-prescribed bed rest 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 back condition.  

BOARD FINDINGS:  In the matter of the chronic 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 20161130, 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-2017-00022.

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,

		

								XXXXXXXXXXXXXXXXXX
								Director
								Air Force Review Boards Agency

Attachment:
Record of Proceedings