RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-01722
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20071119

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an E-4, Tactical Aircraft Maintenance Journeyman, medically separated for “low back pain,” with a disability rating of 10%.

CI CONTENTION:  Requested review of the unfitting 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 - 20071009	VARD - 20080714	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Low Back Pain	5243	10%	Low Back Strain	5237	10%	20080623	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Low Back Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s low back pain began in February 2006 after lifting an object.  An MRI documented degenerative disc disease and arthropathy (disc arthritis), but the CI was not a surgical candidate.  The 29 November 2006 primary care examination, 12 months prior to separation, reported low back pain and spasms that were not relieved with medication.  Physical examination showed a normal posture and no spasms, but spinal tenderness was present.  Thoracolumbar range of motion (ROM) was “full” with painful motion.  

The 20 July 2007 MEB NARSUM examination, 4 months prior to separation, noted complaints of low back pain.  Physical examination showed a normal gait and stance.  During a 2 August 2007 MEB nueromuculoskeletal examination, 3 months prior to separation, the CI reported chronic back pain.  Physical examination showed “lumbar/lumbosacral” flexion to 20 degrees (not VASRD compliant, normal “thoracolumbar” 90), and combined ROM of 80 degrees (normal 240).  At the PT examination on 26 September 2007, 2 months prior to separation, the CI reported ongoing low back pain aggravated by heavy lifting and bending.  Physical examination revealed mid thoracic and upper lumbar spine tenderness.  Goniometric “thoracolumbar” flexion was 60 degrees and combined ROM was 175 degrees, after repetition.  

At the 23 June 2008 VA Compensation and Pension (C&P) examination, 7 months after separation, the CI reported low back pain without flare ups.  Physical examination showed a normal gait and posture without spasm, but spinal tenderness was present.  Lumbar spine flexion was 90 degrees and combined ROM was 240 degrees, after repetition, with painful motion.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, coded 5243 (intervertebral disc syndrome (IVDS)).  The VA also rated the back condition 10%, coded 5237 (lumbosacral strain), based on the C&P examination, citing spinal tenderness.  

The panel deliberated the probative value of the disparate examinations in evidence.  The primary care and VA examinations supported a 10% rating based on painful motion or spinal tenderness; however, they were the furthest from separation.  The nueromuculoskeletal ROM examination measured “lumbar/lumbosacral” flexion but not the VASRD compliant “thoracolumbar” flexion.  The PT ROM examination was closest to separation, and used the VASRD compliant goniometer and measured repetitive “thoracolumbar” flexion to 60 degrees, which warrants a 20% rating.  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), as recorded on the VASRD compliant PT ROM examination most proximate to separation.  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 recommends a disability rating of 20% for the back condition, coded 5243.

BOARD FINDINGS:  In the matter of the back condition, the panel recommends a disability rating of 20%, coded 5243 IAW VASRD §4.71a.  There are no other conditions within the panel’s scope of review for consideration.

The panel recommends the CI’s prior determination be modified as follows, effective the date of medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	
Low Back Pain	5243	20%	

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-2017-01722.

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 not appropriate under the guidelines of the Veterans Affairs Schedule for Rating Disabilities.  Accordingly, the Board recommended modification of your assigned disability rating without re-characterization of your separation with severance pay. 

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding, accept their recommendation and direct that your records be corrected as set forth in the attached copy of a Memorandum for the Chief of Staff, United States Air Force.  This will not result in any change to your separation documents or the amount of severance pay you are entitled to.  Disability severance pay is computed the same regardless of a rating of 0, 10 or 20 percent.