RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01394
BRANCH OF SERVICE:  air force	SEPARATION DATE:  20080625

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

CI CONTENTION:  The VA rated higher for his back condition.  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 - 20080515	VARD - 20080718	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5241	10%	Degenerative Disc Disease, Lumbar Spine	5243	10%	20080123	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:

Chronic Low Back Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI initially developed low back pain with lifting in 2002.  Subsequent imaging (MRI, discography) diagnosed multilevel degenerative disc disease with significant protrusion and possible neural impingement at L5/S1.  In February 2007 he underwent surgical fusion (autograft, L4-S1).  This was complicated by graft slippage of an unclear mechanism and he underwent a surgical revision in June 2007 (12 months before separation).  Post-operative STR entries after the revision surgery documented an uncomplicated course.  Several entries documented non-specific range of motion (ROM) limitation with painful motion, but normal gait and normal spinal contour.  There was no STR documentation of incapacitating episodes after surgical recovery.  

Initial MEB proceedings and an original NARSUM of 31 January 2007 (preceding both surgical procedures) were superseded by the decision to pursue surgery.  An addendum to the NARSUM was dated 04 November 2007 (4 months after final surgery, 8 months prior to separation) and documented “some back discomfort” rated 3-4/10.  The examiner referred to profile restrictions for functional limitations, and the latter included running, bending, lifting, and prolonged standing or sitting.  The physical examination recorded a normal gait without addressing thoracolumbar ROM (albeit noting hip flexion significantly limited to 25-30 degrees) or other VASRD-ratable spine findings.  A subsequent STR entry (17 December 2007, 6 weeks after the NARSUM addendum) noted that the CI re-injured his back from a fall.  An entry of 15 January 2008 (5 months before separation) documented spinal tenderness without spasm and thoracolumbar flexion limited to 25-30 degrees (normal 90), although this was a month after the fall and only shortly after discontinuing a back brace.  

At the 23 January 2008 VA Compensation and Pension (C&P) examination, a week later and still 5 months before separation, the CI reported “steady, but tolerable” pain and a beneficial response to surgery.  The examiner opined that the he was “fully functional” but had limitations with bending, carrying, and lifting (15 pound restriction).  The physical examination recorded a normal gait and non-tender surgical scars without note of spinal tenderness, spasm, or abnormal spinal contour.  Measured ROM was flexion to 65 degrees with combined ROM of 195 degrees (normal 240).  A VA X-ray demonstrated intact hardware and normal alignment.  

Formal ROM measurements for the MEB were performed by physical therapy (PT) on 28 March 2008 (3 months prior to separation).  These were flexion to 80 degrees with a combined ROM of 210 degrees.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the lumbar condition 10%, coded 5241 (spinal fusion), citing application of VASRD criteria.  The VA also rated the condition 10%, coded 5243 (intervertebral disc syndrome), citing the flexion and combined ROM evidence from the C&P.  

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 corroborated by the VA and MEB PT examinations most 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 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 low back condition. 

 

BOARD FINDINGS:  In the matter of the lumbar spine 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 20160224, 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-2017-01394.

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