RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXX	CASE:  PD-2017-00066
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20050617

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Aerospace Ground Equipment Repairer, medically separated for “low back pain” with a disability rating of 20%.  

CI CONTENTION:  “Condition is degenerative and still persistent.”  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 FPEB - 20050310	VARD - 20050830	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Low Back Pain	5237	20%	Lumbar Myofascial Syndrome	5237	20%	20050725	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Low Back Pain (LBP).  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s low back condition began in January 2002 after he had a lumbar puncture for possible meningitis.  The 16 September 2004 MEB NARSUM examination, 9 months prior to separation, noted complaints of constant dull LBP that radiated to both sides.  He had more pain with prolonged sitting and standing, and was only able to work a few hours a day. While he reported instances of bladder and bowel incontinence, he denied any erectile dysfunction.  The examiner noted decreased range of motion (ROM) in flexion and extension (not quantified) and “some difficulty with rotation.”  Muscle strength was 5/5 throughout.  
At a neuromuscular skeletal appointment on 28 March 2005, 3 months before separation, the CI reported constant LBP, rated at 5/10, that increased with any extended activity or positioning.  He stated he was unable to tolerate walking for aerobic activity and had episodes of numbness, with the right leg occasionally buckling.  On examination, thoracolumbar ROM was limited due to subjective complaints of LBP.  

At the 25 July 2005 VA Compensation and Pension (C&P) examination, 1 month after separation, the CI reported LBP with stiffness and severe spasm.  Physical examination showed an antalgic gait with severe guarding and tenderness of the left and right lumbar sacrospinals, but no spasm.  Thoracolumbar flexion was to 40 degrees (normal 90) with a combined ROM of 145 degrees (normal 240); painful motion was noted.  Radiographic imaging the next day revealed no loose pieces and minimal rotoscoliosis convex to the left.  There was a small cleft in the posterior elements of S1, a variant of anatomy, but no loss of vertebral body height, or disc spaces.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back condition 20%, coded 5237 (lumbosacral strain).  The VA also rated the low back condition 20%, also coded 5237, based on the VA C&P examination, citing thoracolumbar forward flexion greater than 30 degrees but not greater than 60 degrees.  The panel agreed that a 20% rating, but no higher, was justified for limitation of flexion as reported on the VA examination.  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 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 back pain and IAW VASRD §4.71a, the panel 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 20161223, 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-2017-00066.

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.