RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00681
BRANCH OF SERVICE:  air force 	SEPARATION DATE:  20061127

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

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 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 - 20061003	VARD - 20080513	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Low Back Pain	5237	0%	Intervertebral Disc Syndrome, Lumbar Spine	5243	10%	20071116	
Polycystic Ovary Disease	Cat II	Polycystic Ovaries	7615	NSC		
Obesity	Cat III	No VA Placement	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Low Back Pain (LBP).  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s back condition began in December 2004 after a motor vehicle crash.  Radiographic (X-ray) studies showed a loss of normal lumbar curvature, but bone scan and MRI were normal.  At the 23 March 2006 physical therapy (PT) clinic appointment, 8 months prior to separation, the CI reported a recent onset of intermittent right-sided mid-upper back pain that was aggravated with prolonged sitting and standing, push-ups, sit-ups, and the stationary upright bike.  On examination, there was increased lumbar lordosis and tenderness, but no evidence of spasm.  Range of motion (ROM) testing showed flexion of 75 degrees (normal 90), and combined ROM greater than 150 degrees but not greater than 215 degrees (normal 240) as there were no rotation measurements, although the examiner noted that rotation was limited and painful.  Motor strength was normal in the lower extremities with the exception of the bilateral great toe flexors which were 4+/5.  Sensation was decreased to light touch at the L3/4 and S1 dermatomes.  Reflexes were normal.  Straight leg raise testing on the left was positive at 70 degrees due to hamstring tightness.  

The 15 August 2006 MEB NARSUM examination, 3 months prior to separation, noted complaints of constant right lower back pain that radiated down her right thigh.  The CI denied weakness or paresthesias in her lower extremities.  She reported that she was unable to run.  Physical examination showed negative straight leg raise testing and normal lower extremity reflexes.  There were no other pertinent findings.  

At the 8 September 2006 orthopedic examination, 2 months prior to separation, the CI complained of 6/10 lower right back pain shooting down the leg (side not specified) with tingling in the right leg.  On examination, there was tenderness to palpation of the right sacroiliac joint.  The examiner document trunk flexion as the ability to reach the hands to the mid tibia (approximates 70-80 degrees of thoracolumbar flexion) and combined ROM greater than 205 degrees but not greater than 220 degrees.  The examiner did not note pain with motion.  Motor strength and reflexes were normal, but sensation was decreased in the left lateral leg and bilateral posterior legs.  Straight leg raise testing was negative.  

At the 16 November 2007 VA Compensation and Pension (C&P) evaluation, 12 months after separation, the CI reported constant 9/10 low back pain that traveled to the right leg.  The CI denied incapacitation.  She was unable to run or do push-ups and sit-ups.  She also could not sit, stand or walk for prolonged periods of time.  Physical examination showed normal gait and spinal contour without evidence of tenderness or spasm.  ROM testing showed flexion of 90 degrees and total combined lumbosacral spine ROM of 240 degrees.  Straight leg raise testing was positive on the right with 4/5 weakness, but negative on the left.  Reflexes were normal.  There was no ankylosis or bowel/bladder dysfunction.  

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%, coded 5243 (intervertebral disc syndrome), citing that although the CI had full ROM, her history of pain was corroborated by the STR and there was evidence of neurological findings of motor weakness in the right leg that warranted a compensable evaluation.  

The panel agreed that a 10% rating, but no higher, was justified for limitation of flexion greater than 60 degrees but not greater than 85 degrees and combined ROM greater than 120 degrees but not greater than 235 degrees, as reported on the PT and orthopedic examinations proximate and prior to separation.  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 of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the low back condition, coded 5237.  

Contended PEB Condition:  Polycystic Ovary Disease.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The contended condition was not profiled, implicated in the commander’s statement nor judged to fail retention standards.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition and so no additional disability rating is recommended.  

Contended PEB Condition:  Obesity.  The panel’s main charge is to assess the fairness of the PEB’s determination that obesity was not a compensable condition.  The panel notes that obesity is a condition not constituting a physical disability, IAW DoDI 1332.38.  Therefore, the panel has no basis for recommending it as unfitting.  After due deliberation, and in consideration of the preponderance of the evidence, the panel concluded that there was insufficient cause to recommend a change in the PEB’s compensability determination for the contended condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the back condition, the panel recommends a disability rating of 10%, coded 5237 IAW VASRD §4.71a.  In the matter of the contended polycystic ovary disease, the panel recommends no change from the PEB determination as not unfitting.  In the matter of the contended obesity condition, the panel unanimously agrees that it cannot recommend it for additional disability rating.  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 as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Low Back Pain	5237	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170221, w/attachments
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 Applicant:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-00681.

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.

						Sincerely,

								XXXXXXXXXXXXXXXXXX
								Director
								Air Force Review Boards Agency

Attachment:
1.  Directive  
2.  Record of Proceedings