RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01861
BRANCH OF SERVICE:  Air Force	SEPARATION DATE:  20081229

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Tactical Aircraft Maintenance Craftsman, medically separated for “lumbago (multiple thoracic disc herniation)” with a disability rating of 10%.

CI CONTENTION:  At the time of separation, he received a 10% rating for his back, no other disabilities were considered, but then the VA rated the CI at 90%.  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 FPEB - 20080908	VARD - 20091029	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Lumbago	5243	10%	Lumbar Strain with Herniated Disc	5237	20%	20090908	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  80%	

ANALYSIS SUMMARY:  

Lumbago.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s lumbago (back pain) condition began in 2001 with no reported injury, but was aggravated by several motor vehicle accidents.  He was treated with medications, duty limitations, and chiropractic manipulation and able to meet duty requirements for several years.  MRI studies in 2005 and 2007 showed thoracic degenerative disc disease and some congenital variations.  His back was not amendable to surgical treatment.  The CI was placed on 24-hour quarters for his back on 30 October 2007, 14 months prior to separation.  
The 25 May 2008 MEB NARSUM examination, 7 months prior to separation, noted complaints of lumbar range of motion (ROM) with tenderness.  Physical examination showed a normal gait, lumbosacral spine tenderness, “normal” ROM (painful motion was not addressed) and lower extremity muscle strength at 5/5.

At the 8 September 2009 VA Compensation and Pension (C&P) general examination, 9 months after separation, the CI reported daily chronic back pain which intermittently radiated to the right lower extremity.  He denied incapacitation due to his back pain.  Physical examination showed a slight right lateral shift in posture with an antalgic gait.  Lumbosacral spine tenderness was present.  Lumbar spine ROM was flexion to 55 degrees (normal 90) and combined ROM was 170 degrees (normal 240); painful motion was present.  No muscle atrophy or spasms with guarding was noted.  Neurological examination was intact.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the lumbago condition 10%, coded 5243 (intervertebral disc syndrome (IVDS)), citing spinal tenderness.  The VA rated the lumbago condition 20%, coded 5237 (lumbosacral strain), based on the C&P general examination, citing limitation of flexion.  

Although the VA examination documented flexion to support a 20% rating, the panel agreed that the preponderance of STR ROM evidence does not support a rating higher that the 10% rating adjudicated by the PEB.  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 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 concluded there was insufficient cause to recommend a change in the PEB adjudication for the lumbago condition.

BOARD FINDINGS:  In the matter of the lumbago condition and IAW VASRD §4.71, 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 20170302, 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-2017-01861.

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