RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01904
BRANCH OF SERVICE:  Air Force	SEPARATION DATE:  20050705

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Heating, Ventilation, Air Conditioning and Refrigeration Journeyman, medically separated for “chronic back pain” with a disability rating of 10%.  

CI CONTENTION:  “My pain level has increased drastically over the years …my work and lifestyle are affected by my disability.”  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 - 20050408	VARD - 20060316	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Back Pain	5237	10%	Thoracic and Lumbosacral Strain	5237	10%	20060215	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Chronic Back Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s low back condition began in May 2004 after lifting a 200-pound water pump while on active military service.  Diagnostic imaging showed very mild thoracic scoliosis with a normal MRI.  The 30 December 2004 MEB NARSUM examination, 7 months prior to separation, noted complaints of persistent low back pain that caused discomfort and an inability to sleep.  Physical examination showed tenderness of bilateral thoracic and lumbar paravertebral muscles, without spasm.  At the time of the pain management clinic appointment on 11 April 2005, 3 months prior to separation, the CI reported low back pain which did not radiate to the legs.  Physical examination showed the CI had a normal gait.  Muscle strength was symmetrically slightly decreased (4/5) in both lower extremities.  Reflexes were normal in all extremities.  The CI had normal flexion and extension, with increased pain during extension.  The CI had muscle spasms with motion of the lower leg (during a negative Patrick test).  At the pain management clinic appointment on 19 August 2005, 1 month after separation, the CI reported chronic back pain.  Physical examination showed the CI walked with a normal gait.  He had back tenderness with normal strength (5/5) and reflexes throughout all extremities.  Straight leg raising test and Patrick test were negative bilaterally.  Thoracolumbar range of motion (ROM) showed flexion and extension were limited secondary to pain.  

At the 15 February 2006 VA Compensation and Pension (C&P) evaluation, 7 months after separation, the CI reported sharp, constant back pain.  Physical examination showed the CI walked with a normal gait.  A mild scoliosis of the thoracic spine was noted, without other deformity.  There was no palpable spasm or weakness noted, but there was some paravertebral spinal tenderness.  Thoracolumbar ROM showed flexion of 80 degrees (normal 90) and combined ROM of 230 degrees (normal 240).  Painful motion was noted.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back condition 10%, coded 5237 (lumbosacral or cervical strain).  The VA also rated the low back condition 10%, coded 5237, based on the C&P examination, citing limitation of forward flexion to 80 degrees, painful motion, and some minimal functional impairment associated with repetitive use and flare-ups.  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) and combined ROM (greater than 120 degrees but not greater than 235 degrees) and the presence of painful motion, as reported on the C&P 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 of 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.  

BOARD FINDINGS:  In the matter of the low 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.  

The following documentary evidence was considered:  

Exhibit A.  DD Form 294, dated 20170208, w/atchs
Exhibit B.  Service Treatment Record  
Exhibit C.  Department of Veterans Affairs Record  

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-01904.

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