RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00601
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20050207

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Security Forces Apprentice, medically separated for “chronic low back pain mechanical” with a disability rating of 10%.   

CI CONTENTION:  The CI submitted a lengthy contention stating her back condition has worsened.  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 - 20040825	VARD - 20050225	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain Mechanical	5237	10%	Lumbar Strain with L5-S1 Midline Disc Protrusion	5243	10%	20041228	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain Mechanical.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s chronic low back condition began in April 2003 while working in security forces and wearing significant weight in gear.  In July and again in August 2003, the CI had injections in her back, which provided only temporary relief.  Magnetic resonance imaging (MRI) of the lumbar spine in October 2003 revealed a midline disc protrusion at L5/S1 that was touching both S1 nerve roots without displacement.  In February 2004, MRI of the thoracic spine was normal.  The CI underwent two sets of epidural steroid injection, neither of which gave lasting relief.  The CI declined further interventions.  

The 20 July 2004 MEB NARSUM examination, 7 months prior to separation, noted complaints of continued low back pain.  Physical examination showed full range of motion (ROM) in flexion and torsion.  At the 5 February 2005 VA Compensation and Pension (C&P) examination, 2 days before separation, the CI reported constant, sharp pain in the lumbar region that radiated up into her shoulder blade.  She also had left hip and buttock burning pain that radiated down to her left knee.  She reported using a muscle relaxer two or three times per week which did help with pain.  Physical examination showed forward flexion to 80 degrees (normal 90) after repetition and combined ROM of 230 degrees (normal 240) with painful motion noted with flexion.  There was no spasm and tenderness was not addressed.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back condition 10%, coded 5237 (lumbosacral strain).  The VA also rated the low back condition 10%, coded 5243 (intervertebral disc syndrome), based on the C&P examination, citing forward flexion greater than 60 degrees but not greater than 85 degrees and combined ROM greater than 120 degrees but not greater than 235 degrees.  The panel agreed there was limitation of forward flexion and combined ROM of the thoracolumbar spine and tenderness to support a 10% rating under the General Rating Formula for Diseases and Injuries of the Spine.  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 (IVDS) with incapacitating episodes, which would provide for a higher rating under that formula (for IVDS).  While the CI may have experienced radiating pain from the back condition, this is subsumed under the general spine rating criteria, which specifically states “with or without symptoms such as pain (whether or not it radiates).”  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 low back condition.  

BOARD FINDINGS:  In the matter of the low back 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 20170217, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-00601.

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,