RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXX 	CASE:  PD-2017-01651
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20091124

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Knowledge Operations Management Craftsman, medically separated for “chronic low back pain” with a disability rating of 20%.  

CI CONTENTION:  No specific contention was 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 - 20090901	VARD – 20100128	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain 	5299-5239	20%	Thoracolumbar Scoliosis 	5299-5239	20%	20090408	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s back condition began gradually in 2002 and worsened while deployed after carrying heavy loads.  X-rays in October 2008 revealed moderate to severe levoscoliosis of the thoracolumbar spine.  

At the 8 April 2009 VA Compensation and Pension (C&P) examination, 9 months before separation, the CI reported stiffness in the morning and worsening back pain with prolonged standing.  She experienced flares twice weekly.  Physical examination showed a normal gait without spasm, guarding or tenderness.  The thoracolumbar range of motion (ROM) study showed flexion of 60 degrees (normal 90) and combined ROM of 150 degrees (normal 240) with painful motion.  Thoracolumbar scoliosis was diagnosed.  

The 20 May 2009 MEB NARSUM addendum, 6 months prior to separation, noted complaints of back pain (7/10) with numbness and tingling sensations, but no radiation of the pain.  The CI was unable to sit for longer than 2-3 hours.  Limitation was due to buttock numbness in the midline and pain in the left buttock.  Physical examination showed a normal gait.  At the time of the primary care clinic appointment on 9 September 2009, 2 months prior to separation, the CI reported constant low back pain (7/10).  On examination the gait was normal, but there was tenderness.  The CI had full lumbar ROM with pain at the end range of flexion.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 20%, analogously coded 5239 (spondylolisthesis or segmental instability).  The VA also rated the back condition 20%, analogously coded 5239, based on the STR, citing forward flexion of 60 degrees. Although the October 2008 X-rays revealed mild scoliosis, there was no examination evidence at the time that confirmed the presence of muscle spasm or guarding.  The mild scoliosis was consistent with a developmental curvature commonly seen as an incidental finding.  The panel agreed that a 20% rating, but no higher, was justified for limitation of flexion (greater than 30 degrees but not greater than 60 degrees).  There was no documentation of intervertebral disc syndrome with incapacitating episodes which would provide for a higher rating under that formula.  Therefore, the panel concluded there was no evidence to support a rating higher than the 20% adjudicated by the PEB.  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.  

	

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

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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-2017-01651.

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.