RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00481
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20060403

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Security Forces Journeyman, medically separated for “chronic recurrent low back pain, existed prior to service (EPTS), with Service aggravation” with a disability rating of 10%.  

CI CONTENTION:  “Back pain is still an issue…”  The CI requested review of an additional condition not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB).  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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the 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 - 20060215	VARD - 20060829	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Recurrent LBP…	5237	10%	Chronic LBP	5242	10%	20060716	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Chronic Recurrent Low Back Pain (LBP), EPTS, with Service Aggravation.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s low back condition began either after he missed a step while walking down stairs, jarring his back, or from loading a heavy weapon.  The initial X-rays were normal and he was prescribed medications.  An MRI showed congenital narrowing of the spinal canal and degenerative changes at L4-5 and L5-S1 with no evidence of neural impingement.  Despite duty limitations, medications, epidural injections, and ablation, the CI remained limited in his work function and an MEB was initiated.  

The 23 October 2005 MEB NARSUM examination, 6 months prior to separation, noted the above history.  On physical examination he was noted to have severe muscle tenderness with spasm.  The neurological examination was intact.  The range of motion (ROM) and gait were not recorded.  In neurology on 7 December 2005, the CI was noted to have a normal gait and neurological examination without muscle atrophy.  

At the 17 July 2006 VA Compensation and Pension (C&P) examination, 3 months after separation, the CI reported no incapacitation in the prior 12 months.  He denied limitations in daily activity but complained of stiffness and being unable to move during flare up weakness in right leg due to the back condition. The pain occurred 3 times per week and each time lasted for 2 days.  The characteristic of the pain was crushing in nature, burning in nature, and sharp in nature.  Pain level was at 8/10.  Physical examination showed normal posture and gait; no assistive device was used.  ROM measurements were recorded as flexion of 90 degrees (normal 90) and combined ROM of 240 degrees (normal 240) without mention of painful motion.  There was no tenderness.  There was no additional limitation with repetition.  The neurological examination was normal.  X-rays showed degenerative arthritis.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic recurrent LBP condition 10%, coded 5237 (lumbosacral strain), citing degenerative facet changes on an MRI.  The VA also rated the chronic LBP condition 10%, coded 5242 (degenerative arthritis of the spine), based on the C&P examination, citing painful motion.  

Although there was insufficient limitation of motion to support a 10% rating, the panel agreed a 10% rating was justified for the presence of tenderness.  Although there was muscle spasm, 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 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 chronic LBP condition.  

BOARD FINDINGS:  In the matter of the chronic recurrent LBP condition 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 20170213, 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

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-00481.

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