RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-00037
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20060614

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Special Purpose Vehicle and Equipment Maintenance Journeyman, medically separated for “low back pain” with a disability rating of 0%.  

CI CONTENTION:  His condition continues to worsen and negatively impact daily activities.  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 Medical Evaluation Board (MEB), but determined by the PEB 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.  The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence relevant to application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards for 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, which operates 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 disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20060501	VARD - 20070328	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Low Back Pain	5237	0%	Lumbar Muscle Strain	5237	10%	20070216	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Low Back Pain (LBP).  According to the service treatment record and MEB narrative summary (NARSUM), the CI had a history of episodic back pain that was exacerbated after he went 4-wheeling in July 2005.  He described pain in the center of the lower spine with no radiation, and reported no specific injury or trauma.  The pain worsened over the next few months, and he was disqualified from a remote assignment in October 2005 due to his profile restrictions.  An MRI on 25 October 2005 was normal and an X-ray from the same timeframe demonstrated mild lumbar spine curvature, but was otherwise normal.  

At the family practice clinic visit on 22 November 2005, the CI claimed that despite physical therapy (PT) and medications, his pain was not improving and he had a constant, dull ache worsened by standing or sitting for prolonged periods; he denied radiation into the lower extremities.  Physical examination revealed mild spinous process tenderness from L5-S1, but not elsewhere, and continued PT was recommended.  At a 7 February 2006 family practice follow-up, the CI reported continued LBP, and the provider recorded thoracolumbar range of motion (ROM) of flexion to 45 degrees (normal 90), extension to 10 degrees (normal 30), and lateral flexion bilaterally to 20 degrees (normal 30).  

The 23 February 2006 MEB NARSUM examination, 4 months prior to separation, documented flexion of 90 degrees and combined ROM of 190 (normal 240), but the examiner was silent regarding painful motion, guarding, tenderness, spasm, gait, or spinal contour.  During the 23 May 2006 MEB examination (recorded on DD Forms 2697), approximately 1 month before separation, the provider recorded lumbar paraspinal tenderness.  

At the 16 February 2007 VA Compensation and Pension (C&P) examination, 8 months after separation, the CI reported intermittent LBP and stiffness, but denied weakness or radiation into the extremities.  He had flare-ups about once or twice monthly, with a severity of 3/10, which lasted for a day.  He also reported one incapacitating episode in the previous 12 months that lasted for 2-3 days when he was put on quarters.  Physical examination showed crutch ambulation status post left tibia and fibula fracture.  Back curvature was normal with mild lumbar paraspinous tenderness.  After repetition, flexion was to 70 degrees with a combined ROM of 175 degrees.  Painful motion was noted, but the provider did not report spasm or guarding.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 0%, coded 5237 (lumbosacral strain).  The VA rated the back condition 10%, also coded 5237, based on the C&P examination, citing painful and limited ROM.    Members noted that the limitation of flexion recorded at the family practice visit met the threshold for a 20% rating.  However, both the NARSUM and VA examinations noted flexion that was consistent with service outpatient treatment notes closer to separation, and thus the panel relied more heavily on those ROM measurements.  Members agreed that 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 VA examination, combined ROM (greater than 120 degrees but not greater than 235 degrees) as reported on the NARSUM and VA examinations; and localized tenderness not resulting in an abnormal gait as documented on the MEB examination.  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 the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the back condition, coded 5237.  

BOARD FINDINGS:  In the matter of the low back pain condition, the panel recommends a disability rating of 10%, 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 the date of medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Lower Back Pain	5237	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20161206, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD 20762

XXXXXXXXXX
XXXXXXXXXX
XXXXXXXXXX

Dear XXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-00037.

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.  Accordingly, the Board recommended modification of your assigned disability rating without re-characterization of your separation with severance pay. 

I have 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.  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.

							

Attachments:
1.  Directive
2.  Record of Proceedings