RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-01205
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20060801

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

CI CONTENTION:  “Please 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 - 20060519	VARD - 20070725	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Back Pain 	5299-5239	10%	Thoracolumbar Scoliosis	5236	10%	20070523	
Tobacco Habituation	Cat III	No VA Placement	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Chronic Back Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s back pain began in 2003 after giving birth to her daughter, and she reported being unable to wear her 50-pound pack and difficulty performing aircraft fueling duties.  The 27 January 2006 MEB NARSUM examination, 6 months prior to separation, noted complaints of back pain aggravated by prolonged bending, squatting and standing.  Physical examination showed thoracolumbar spine tenderness, but full range of motion (ROM).  The CI was hyperflexible and able to back bend and bend forward and place her palms on the floor.  An MRI in March 2006 revealed scoliosis, but there was no significant central or lateral recess or neural foraminal stenosis.  

At the pain management appointment on 4 April 2006, 4 months before separation, the CI reported low back pain and stiffness.  The examiner noted tenderness over the L3-L5 region, and decrease lumbar spine ROM (not quantified) with pain on extension.  During a family practice visit on 7 April 2006, the CI complained of low back pain.  The provider documented tenderness and scoliosis, but gait, stance, sensation and deep tendon reflexes were all normal.  

At the 23 May 2007 VA Compensation and Pension (C&P) examination, 10 months after separation, the CI reported discomfort in the lower and mid back aggravated by prolonged standing, walking, sitting, bending, stooping and heavy lifting; she denied any radicular symptoms.  Physical examination showed a normal gait and posture, and the ability to heel and toe walk as well as fully squat.  Examination of the thoracolumbar spine revealed moderate scoliosis, but no localized tenderness.  Flexion was to 85 degrees (normal 90) and combined ROM was 230 degrees (normal 240).  There was no pain with ROM testing, and no further loss of motion after repetition.  Straight leg raise testing was negative and there was no sensory, motor or reflex deficit present.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, analogously coded 5239 (spondylolisthesis or segmental instability).  The VA also rated the back condition 10%, but coded 5236 (sacroiliac injury and weakness), based on the VA C&P examination, citing 10% criteria for thoracolumbar forward flexion and combined ROM.  Members 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 VA C&P examination and supported by the presence of painful motion and tenderness from other examinations proximate 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 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.  

Contended PEB Condition:  Tobacco Habituation.  This condition is not a condition constituting a physical disability IAW DODI 1332.38.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition, so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the chronic back pain and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended tobacco habituation, the panel agrees it cannot recommend it for additional disability rating.  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.  

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD 20762

XXXXXXXXXX
XXXXXXXXXX
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Dear XXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-01205.

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.