RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02013
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20080115

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6, Avionics Systems Apprentice, medically separated for “low back pain” with a disability rating of 20%. 

CI CONTENTION:  The CI made no specific contention.  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 - 20071102	VARD - 20080514	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Low Back Pain	5243	20%	Strain, Low Back, with Mild Degenerative Changes	5237	10%	20080403	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:

Low Back Pain (LBP).  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s LBP began in 2003 but was exacerbated in December 2006 when he slipped on ice and twisted his back.  Radiographic studies showed disk facet arthropathy (disk joint disease), internal disc (disk irritated), and spinal canal narrowing.  A neurosurgical consultation recommended physical therapy without surgical intervention.

The 19 June 2007 neurosurgery examination, 7 months prior to separation, noted constant LBP with right leg pain and numbness.  The LBP was aggravated by prolonged standing or changing positions.  Physical examination showed reduced range of motion (ROM) secondary to pain.  Motor strength and sensation were normal and straight leg raise testing was negative.  The 10 September 2007 physical therapy (PT) examination, 4 months prior to separation, noted complaints of back pain, but the right leg pain had resolved.  Physical examination showed spinal tenderness.  Trunk ROM was “within normal limits,” but painful motion was present.  The 4 October 2007 MEB NARSUM examination, 3 months prior to separation, repeated the 19 June 2007 neurosurgery clinic examination findings above.  The 15 October 2007 PT examination, 3 months prior to separation, noted complaints of back pain.  Physical examination showed an antalgic gait, spinal tenderness and muscle spasm.  Thoracolumbar ROM was flexion of 80 degrees (normal 90) but combined ROM was incomplete; painful motion was not addressed.

At the 3 April 2008 VA Compensation and Pension (C&P) evaluation, 3 months after separation, the CI reported back pain that radiated to the right thigh.  Physical examination showed a normal gait and posture.  There was no spinal tenderness or muscle spasm.  Sensory testing was intact and motor strength was 5/5.  Thoracolumbar ROM was flexion to 90 degrees and combined ROM was 240 (normal); painful motion was present.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 20%, coded 5237 (lumbar spine strain).  The VA rated the back condition 10%, coded 5237 (lumbosacral strain), based on the C&P examination, citing functional limitations due to pain.  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, based on the totality of ROM examinations proximate to separation.  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.  There was no other available rating higher than the 20% adjudicated by the PEB.  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 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.

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 Treatment 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-2017-02013.

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