RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00704
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20090527

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Aerospace Medical Service Journeyman, medically separated for “chronic low back pain” with a disability rating of 10%.  

CI CONTENTION:  “These issues are still impacting my daily life and work life.”  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 - 20090310	VARD - 20090831	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5243	20%	Degenerative Disc Disease at the L5-S1	5243	10%	20090519	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent disk replacement surgery in May 2008.  She reinjured her back performing sit-ups in August 2008.  The 9 October 2008 MEB NARSUM examination, 7 months prior to separation, noted complaints of pain in the middle and lower back, and occasional numbness and tingling in the right leg and foot.  She reported an inability to run or do sit-ups.  Excessive bending and prolonged sitting aggravated the pain.  Physical examination showed tenderness, full range of motion (ROM) and normal reflexes.  At the neurology clinic appointment on 14 January 2009, 4 months prior to separation, the CI reported back pain, which radiated down the buttocks to the feet.  She denied motor deficits, but did have some intermittent numbness and tingling in the right leg.  On examination, there was tenderness.  ROM testing showed flexion of 60 degrees (normal 90) and right/left lateral flexion at 15 degrees each (normal 30).  No other planes of motion were reported.  Reflexes and sensation were normal.  

At the 15 May 2009 VA Compensation and Pension (C&P) examination, 1 week before separation, the CI reported flare-ups once per week that lasted all day for 2-3 days and made her unable to work.  Physical examination noted tenderness, but gait was normal and there was no spasm or guarding.  ROM testing showed flexion of 90 degrees and combined ROM of 230 degrees (normal 240), with pain at the terminal ends with repetition.  Strength and reflexes were normal.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 20%, coded 5243 (intervertebral disk syndrome), citing limitation of forward flexion to 60 degrees.  The VA rated the back condition 10%, coded 5243, based on the C&P examination, citing combined ROM of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees.  The panel concluded there was no evidence to support a rating higher than that adjudicated by the PEB.  There was no evidence of intervertebral disc syndrome which resulted in incapacitating episodes requiring physician-prescribed bed rest to warrant consideration of rating under the alternate VASRD formula for that condition.  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 back condition.  

BOARD FINDINGS:  In the matter of the back condition and IAW VASRD §4.71, 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 20170221, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs 

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-2017-00704.

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