RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01462
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20060515

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

CI CONTENTION:  The LBP continues to worsen and impact daily activities. The VA rating was higher and included gastroesophageal reflux disease (GERD). 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 - 20060328	VARD - 20060915	
Condition	Code	Rating	Condition	Code	Rating	Exam	
LBP	5243	10%	Chronic Thoracolumbar Strain Status Post Neurotomy	5237	10%	20060712	
GERD	Not Unfitting	GERD	7399-7346	10%	20060712	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

LBP.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s low back condition began in January 2003 during basic training and resolved with physical therapy and chiropractic treatments.  In January 2005 he developed an acute flare of LBP after a motor vehicle accident.  Treatment consisted of Motrin (ibuprofen, a nonsteroidal anti-inflammatory drug (NSAID)) and Percocet (oxycodone, a narcotic, and acetaminophen, a pain reliever).  The CI was seen on 22 March 2005 by an anesthesiology pain medicine consultant, who noted an MRI showed an essentially normal lumbar spine and a spina bifida occulta (a gap in the vertebrae) at S1.  On examination he flexed approximately 6 inches from the floor and extended 20 to 30 degrees, which resulted in a well-localized left perivertebral region pain provocation.  Straight leg raising (to determine nerve root irritation) was negative.  He did have left piriformis stretching tenderness.  Physical therapy was recommended along with consideration of trigger point injections or facet joint or medial branch injections.  

The CI underwent chiropractic evaluation on 3 June 2005 at which time he had full range of motion (ROM) with pain with extension.  The examiner’s impression was lumbar spine facet syndrome with sacroiliac joint dysfunction by tight hip flexors; treatment including chiropractic manipulation was instituted.  An MRI of the lumbar spine dated 27 July 2005 was negative.  The 6 March 2006 MEB NARSUM examination, 2 months prior to separation, noted the complaint of LBP.  Physical examination showed mild tenderness to the spinous processes at the L4-5 region which extended bilaterally to the paraspinous muscles.

At the 12 July 2006 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported chronic LBP with increased pain when lifting or bending and during extended standing.  Physical examination showed no deformities or asymmetry of the lumbar spine on inspection or palpation.  Forward flexion was 90 degrees with pain and normal combined ROM (240) with pain on extension at 20 degrees.  There was no decreased function on repetitive movement.  Lasegue’s sign (to determine lumbar radiculopathy) was negative and straight leg raising did induce lower back pain bilaterally.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back condition 10%, coded 5243 (intervertebral disc syndrome [IVDS]) citing Department of Defense and VASRD guidelines.  The VA  also rated the chronic thoracolumbar strain 10%, coded 5237 (lumbosacral strain), based on the C&P examination, citing painful motion or loss of ROM due to pain of a group of minor joints.

Although there was insufficient limitation of motion to support a minimum rating, the panel agreed a 10% rating was justified for the presence of tenderness.  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 IVDS 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 low back condition.  

Contended PEB Condition:  GERD.  The panel’s main charge is to assess the fairness of the PEB determination that the contended condition was not unfitting.  The contended condition was not profiled, implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  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 low back condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended GERD condition, the panel recommends no change from the PEB determination as not unfitting.  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 20170222, 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-2017-01462.

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