SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD 20762

XXXXXXXXXX
XXXXXXXXXX
XXXXXXXXXX

Dear XXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-02287.

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,

								XXXXXXXXXX

Attachment:
Record of Proceedings 

RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-02287
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20091115

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a Reserve E6, Aircrew Flight Equipment Craftsman, medically separated for “chronic low back pain, with discogenic disease and annular tearing of L4-5 and L5-S1” with a disability rating of 20%.  

CI CONTENTION:  Review all conditions. 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 - 20091001	VARD - 20091119	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain…	5243	20%	Thoracolumbar Spine Degenerative Disc Disease w/ Degenerative Joint Disease 	5243	20%	20090716	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain (LBP).  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s LBP began in 2001, and in 2005, he underwent an intradiscal electrothermal anuloplasy which provided relief until 2008.  At a family practice visit in June 2008, he complained of LBP with radiation into the posterior aspect of the left thigh.  An MRI showed mild disc bulging at L3-4 and L5-S1, and lumbar X-rays showed degenerative joint disease of the lumbar spine with osteophyte formation and disc space narrowing.  An EMG revealed no lumbar radiculopathy, and an orthopedic spine specialist did not recommend surgery.  
The 7 March 2009 MEB NARSUM examination, 8 months prior to separation, noted CI complaints of LBP for which he took a narcotic pain reliever.  He stated that daily pain limited activities to include cleaning, gardening, working on his car, outdoor activities, and exercise.  Physical examination showed pain with lumbosacral spine palpation, greater on the right than left side, pain during flexion and extension, and positive radicular testing.  Thoracolumbar range of motion (ROM) measurements performed by physical therapy (PT) for the MEB on 5 February 2009, 9 months prior to separation, showed flexion of 48 degrees (normal 90) and combined ROM of 206 degrees (normal 240) after repetition.  

At the 16 July 2009 VA Compensation and Pension (C&P) examination, 4 months before separation, the CI reported LBP, and the examiner documented flattening of the normal lumbar lordosis, paraspinal tenderness, and tension in the thoracolumbar spine.  Gait was normal, and there was no evidence of radiating pain on movement, muscle spasm, or ankylosis; straight leg raise testing was negative bilaterally.  Thoracolumbar ROM measurements showed flexion of 40 degrees and combined ROM of 170 degrees, with painful motion.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back condition 20%, coded 5243 (intervertebral disc syndrome (IVDS)).  The VA also rated the back condition 20%, coded 5243, based on the C&P examination, citing thoracolumbar spine flexion greater than 30 degrees but not greater than 60 degrees; or combined ROM not greater than 120 degrees.  Members agreed that a 20% rating, but no higher, was justified for limitation of flexion.  There was no evidence of IVDS which resulted in incapacitating episodes requiring physician-prescribed bed rest to warrant consideration of rating under that alternate 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 back condition.  

BOARD FINDINGS:  In the matter of the chronic low back pain 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 20170302, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record