RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01662
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20080403

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty, E6, Aerospace Propulsion Craftsman, medically separated for “chronic low back pain, status-post (S/P) lumbar fusion of L5-S1” with a disability rating of 10%.   

CI CONTENTION:  “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 - 20080114	VARD - 20090229	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain, S/P Lumbar Fusion of L5-S1	5241	10%	Spondylolisthesis L5/S1 Post Fusion Surgery with Surgical Scar	5242	10%	20081126	
Asthma	Cat II	Asthma	6602	10%	STR	
Obesity	Cat III	No VA Placement	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Low Back Pain.  According to the service treatment record (STR) and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent multiple back procedures in 2002.  He then had an additional back surgery with posterior laminectomy and discectomy L5-S1 in April 2003.  Further treatment to include facet joint injections in August and October 2007 was unsuccessful at resolving the pain.    

At the 3 October 2007 physical therapy (PT) appointment for the MEB, lumbar range of motion (ROM) measurements were recorded as flexion of 65 degrees (normal 90) and a combined ROM of 180 degrees (normal 240), with pain on all planes.  Flexion and extension were measured with a bubble inclinometer; all other planes were measured with a goniometer.  Gait was normal, as was strength and heel-to-toe movement.  The 19 November 2007 Pain and Spine Center appointment, recorded complaints of lumbar spine pain radiating to the left lower extremity, described as aching and constant, and made worse by standing and walking.  It was relieved by use of a TENS unit.  Gait and strength were normal and the lumbar/sacral examination noted no tenderness.  ROM was flexion of 60 degrees, with extension and right/left lateral bending each at 25 degrees (normal 30).  The examiner noted that the CI’s condition was improving. 

The 29 November 2007 MEB NARSUM examination, 4 months prior to separation, noted no specific complaints.  Physical examination referenced the previous PT ROM and a 2 November 2007 neurosurgeon appointment where the CI reported his October 2007 facet point injection had relieved the majority of his leg pain, but that he continued to experience lower back and leg pain.  

At the 26 November 2008 VA Compensation and Pension (C&P) evaluation, 7 months after separation, the CI reported daily pain of 2/3-10 with flare-ups to 6/7-10 which limited mobility to 75 percent.  Physical examination showed full ROM with no pain on motion, normal strength and gait described as “limping, slow propulsion.”  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, coded 5241 (spinal fusion).  The VA rated the back condition 10%, coded 5242 (degenerative arthritis of the spine), based on the C&P examination.  The panel discussed the various examinations and found the PT examination more thorough and thus more probative.  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 reported on the MEB PT examination.  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 low back condition.  

Contended PEB Conditions:  Asthma, Obesity.  The panel’s main charge is to assess the fairness of the PEB’s determination that asthma and obesity were not unfitting.  Asthma was profiled throughout the record, but not mentioned in the final duty-limiting report.  Although the commander’s statement referenced the CI could not wear a respirator or gas mask or complete the run portion of the fitness test, there was no performance-based evidence from the record that asthma significantly interfered with satisfactory duty performance at separation.  The CI was allowed to perform the walk and swim PT tests both of which cause heavy respiratory effort.  The CI’s performance reports showed that he had no detriment in his work performance due to asthma.  After due deliberation, and in consideration of the preponderance of the evidence, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition and so no additional disability rating is recommended.

Obesity is a condition not constituting a physical disability, IAW DoDI 1332.38 (E5.1.2.10).  Therefore, the panel has no basis for recommending it as unfitting.  After due deliberation, and in consideration of the preponderance of the evidence, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition and 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 asthma and obesity conditions, the panel recommends no change from the PEB determinations 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 20170223, 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-2017-01662.

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