RECORD OF PROCeediNGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-01767
BRANCH OF SERVICE:  air force	SEPARATION DATE:  20050829

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Vehicle Operations Craftsman, medically separated for “chronic low back pain” with a disability rating of 10%.

CI CONTENTION:  The condition continues to worsen and negatively affects daily activities.  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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the MEB (Medical Evaluation Board), but determined by the Physical Evaluation Board (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 - 20050714	VARD - 20061018	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain 	5243	10%	L4-L5 Degenerative Disc Disease 	5243	60%	20060706	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:

Chronic Low Back Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent back surgery (L4-L5 lumbar discectomy) in May 2003.  Postoperative rehabilitation was successful, and the CI returned to normal work.  In August 2004, the CI reinjured his back during a ruck-march.  The CI declined further surgical intervention.  At the 12 January 2005 MEB NARSUM examination, 8 month prior to separation, the CI reported chronic low back pain.  Physical examination revealed a normal gait, but the CI could not heel walk on the right foot.  There was minimal decrease in vibration sense at the toes.  Spine range of motion (ROM) was “full.”  Painful motion, spinal contour, tenderness and muscle spasm were not addressed. 

The pain management examination on 22 April 2005, 4 months prior to separation, revealed a normal gait and the ability to heel and toe walk.  There was spinal tenderness, but spinal flexion and extension were “normal.”  Painful motion was not addressed.  During the primary care examination on 28 July 2005, 1 month prior to separation, the CI reported aggravation of back pain when standing from a sitting position, which was greater than prior to surgery.  Physical examination revealed spinal tenderness and “decreased” spinal ROM, noting flexion to “proximal thigh.”  The pain management examination on 31 March 2006, 7 months after separation, documented the CI’s ability to perform activities of daily living, although he had to push through the back pain.  Physical examination showed a normal gait and no significant spinal muscle spasm.  Spinal ROM was restricted (not quantified).  Painful motion, tenderness and spinal contour were not addressed. 

At the 6 July 2006, VA Compensation and Pension (C&P) examination, 10 month after separation, the CI reported low back pain.  Physical examination showed normal gait and posture.  Lumbar spine flexion was 45 degrees (normal 90) and combined ROM was 120 degrees (normal 240).  Painful motion was present.  Spinal tenderness and muscle spasm were not addressed. 

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 rated the back condition 60%, also coded 5243, based on the C&P examination, citing IVDS incapacitating episodes of total duration of at least 6 weeks during the past 12 months.  The panel agreed that at the time of separation there was no limitation of thoracolumbar spine motion to support a 10% rating.  Panel members determined the post-separation VA ROM examination to be an outlier.  However, there was sufficient evidence of localized-spinal tenderness to support a 10% rating.  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.  Although the VA granted a 60% rating for IVDS incapacitating episodes, the panel agreed there was no documentation of incapacitating episodes requiring physician-prescribed bed rest to support a rating higher than the 10% 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-2017-01767.

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.