RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00991
BRANCH OF SERVICE:  Air Force	SEPARATION DATE:  20070727

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Ground Radio Communication Craftsman, medically separated for “low back pain due to degenerative disc disease [DDD]” with a disability rating of 10%.  

CI CONTENTION:  His 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 - 20070621	VARD - 20071121	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Low Back Pain Due to DDD Status Post (S/P) Discectomy	5243	10%	Lumbar Disc Disease L5-S1 S/P Percutaneous Discectomy	5010-5242	10%	20071108	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Low Back Pain (LBP) Due to DDD Status Post Discectomy.  According to service treatment records and MEB narrative summary (NARSUM), the CI reported that his LBP condition began in 2001 to 2002 time period, while moving shop cabinets.  He did not seek treatment at that time.  He has been seen on multiple occasions since January 2004.  The CI underwent a percutaneous discectomy in October 2006, without complications, however, the CI reported no improvement.  At the 19 September 2006 MEB NARSUM examination, approximately 10 months prior to separation, the CI reported back spasms with intense pain.  Physical examination showed a normal gait and posture.  Lumbar tenderness and spasms were present.  Neurologic examination was intact.  He demonstrated a full range of motion (ROM) of his lumbar spine.  Numerical measurements were not recorded on this examination.  Pain was elicited with lumbar flexion and extension.  

During the 25 January 2007 MEB Addendum, approximately 6 months prior to separation, the CI reported continued back pain.  Physical examination showed significant forward flexion.  He was able to reach his mid tibia with his hands.  Lumbar extension was within normal limits (WNL) and mild pain was elicited.  His ability to bend to the left and right side was WNL.  Lumbar rotation in both directions was WNL.  Muscle strength was 5/5, bilaterally.  A 19 June 2007 MEB Addendum, approximately 1 month prior to separation, showed the CI’s ROM was evaluated.  Forward flexion was 95 degrees (normal 90) with combined ROM at 235 degrees (normal 240).  (Note:  Although, the addendum was dated 19 June 2007, the provider reported the ROM studies were completed on 12 June 2007.)  No other physical examination findings were noted such as whether or not pain was elicited with motion.  

At the 8 November 2007 VA Compensation and Pension (C&P) evaluation, approximately 4 months after separation, the CI reported an intermittent course with remissions, since onset.  Response to treatment has been fair, which included:  cyclobenzaprine, ibuprofen, steroid injections and percutaneous discectomy.  Physical examination showed a normal gait.  There was no abnormal spinal curvature, tenderness, guarding or spasm.  Neurological exam of the lower extremities was normal, which included negative straight leg raise tests, bilaterally.  Forward flexion was 90 degrees (normal) with combined ROM at 240 degrees (normal).  There was pain on motion.  X-rays showed minimal narrowing of the L4-L5 interspace.  Lumbar spine was otherwise negative.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the LBP due to DDD condition 10%, coded 5243 (intervertebral disc syndrome).  The VA also rated the lumbar disc disease condition 10%, coded 5010-5242 (arthritis, due to trauma-degenerative arthritis of the spine) based on the C&P examination 4 months after separation, citing normal ROM with objective evidence of pain at the extreme of motion.  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), as reported on the NARSUM and VA examinations.  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.  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 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 20170226, 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-2017-00991.

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