RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01316
BRANCH OF SERVICE:  AIR FORCE 	SEPARATION DATE:  20050420

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an Air National Guard E7, General Purpose Vehicle Mechanic, medically separated for “chronic low back pain” with a disability rating of 10%.

CI CONTENTION:  No specific contention made.  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 - 20041027	VARD - 20060124	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5243	10%	Multilevel Degenerative Changes of the Lumbosacral Spine 	5242	20%	20051007	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain.  According to the service treatment record, the CI was noted to have significant degenerative disc disease (DDD) at L3-4 and L5-S1 at least as early as January 1986.  However, the MEB narrative summary (NARSUM) reported that the CI’s back condition began in March 2004 while lifting batteries during a weekend drill.  An MRI of the lumbar spine dated April 2004 showed multilevel degenerative disc changes at L2-3 through L5-S1.  There was no evidence of canal stenosis or possible nerve impingement secondary to a herniated disc.  At the 25 August 2004 orthopedic clinic visit, 8 months prior to separation, the examiner recorded that the CI’s back pain had improved after discontinuing mechanic work, but the CI was still having leg pain, especially on the left, which was mostly attributable to his arthritic left knee.  However, the CI occasionally had pain down to the feet bilaterally with numbness and tingling into the legs.  He could walk without any major issues.  On examination, he was able to move around fairly well.  Range of motion (ROM) testing showed normal flexion (90 degrees) and limitation of extension at 50% (normal 30 degrees).  There was pain to palpation of the lower lumbar spine.  Motor strength was normal except for an equivocal slight decrease along the extensor hallucis longus at 4/5, but sensation and reflexes were normal.  

The 8 September 2004 MEB NARSUM physical examination, 7 months prior to separation, showed essentially normal ROM with some limitation due to obesity.  Motor strength, sensation, and reflexes were normal and provocative maneuvers to elicit nerve root pain were negative.  “There were no other acute findings regarding [the CI’s] back.”  The examiner noted a “workability report” which concluded that the CI was permanently disabled and required position changes every 30 minutes with a lift/carry maximum of 15 pounds.  

At the 7 October 2005 VA Compensation and Pension (C&P) general medical examination, 6 months after separation, the CI reported constant pain across the lower back with rare episodes of radiation into the lower legs.  He denied any numbness, tingling, or weakness, but reported that his back pain was aggravated by walking, standing, bending, lifting, twisting, squatting, or going up and down stairs.  He also reported that he had back pain flares at least once a month, which were associated with severe muscle spasms that lasted for “several days up to about a week at its worst.”  Physical examination showed a stiff gait that loosened up and was otherwise normal after the CI walked around the examination room.  There was no tenderness or spasm palpated.  ROM testing showed forward flexion of 70 degrees and combined thoracolumbar ROM of 190 degrees (normal 240).  The examiner did not address painful motion.  Motor strength, sensation, and reflexes were normal.  Straight leg raise testing was negative from the seated position, but while lying down the CI felt some pulling discomfort in the lower back at 45 degrees bilaterally.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, coded 5243 (intervertebral disc syndrome), citing DoD and VASRD guidelines.  The VA rated the back condition 20%, coded 5242 (degenerative arthritis of the spine), based on the C&P examination, citing forward flexion of 70 degrees with an overall disability picture that most closely approximated forward flexion of the thoracolumbar spine greater than 30 degrees, but not greater than 60 degrees, based on flares that would likely limit movement of the lumbosacral spine when pain was at its worst.

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/or combined ROM greater than 120 degrees but not greater than 235 degrees, as reported on the 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.  

BOARD FINDINGS:  In the matter of the 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 20170202, 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-2017-01316.

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