RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01536
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20070411

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6, Aircrew Life Support, medically separated for “chronic low back pain, degenerative disc disease [DDD]” with a 10% disability rating.  

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 - 20070124	VARD - 20070829	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain, DDD	5243	10%	DDD of the Lumbar Spine	5243	10%	20070628	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain, DDD.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s low back condition began in approximately 1998 without specific trauma and continued with intermittent exacerbations.  MRI performed on 25 September 2006 showed multilevel DDD with a lateral disc protrusion at L4-5 causing mild narrowing of the neural foramen without compromising the exiting nerve root.  The CI was treated conservatively with minimal improvement in her back pain.  Physical therapy (PT) measured range of motion (ROM) for the PEB on 28 November 2006 and trunk flexion was 70 degrees (normal 90) with combined ROM of 200 degrees (normal 240).  
The 5 December 2006 MEB NARSUM examination, 4 months prior to separation, noted complaints of almost constant back pain aggravated by prolonged standing, sit-ups and running.  The CI reported pain exacerbations one to two times per month.  Physical examination showed a normal gait.  There was no tenderness over the spine or spinal deformity.  There was “minimal” paraspinal muscle spasm.  The MEB NARSUM cited the November ROM obtained by PT.  

At the 28 June 2007 VA Compensation and Pension (C&P) examination, 3 months after separation, the CI reported localized low back pain most days, with an occasional flare-up.  Physical examination showed there was normal symmetry of the low back, with tenderness along the spinal column.  There were no muscle spasms and no radiation of pain.  Low back ROM was flexion of 80 degrees and combined ROM of 210 degrees.  With repetitive ROM there was pain with extension, which further limited combined ROM to 200 degrees.  

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), citing DoDI guidelines and the VASRD.  The VA also rated the DDD of the lumbar spine condition 10%, coded 5243, based on the C&P examination, citing pain and limitation of combined ROM.  

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 combined ROM (greater than 120 degrees but not greater than 235 degrees) as reported on the MEB NARSUM and VA examinations proximate to separation.  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 low 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 20170306, 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-2017-01536.

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