RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX 	CASE:  PD-2017-02347
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20090625

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Aircraft Armament Systems Journeyman, medically separated for “low back pain” 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 – 20090318	VARD - 20100506	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Low Back Pain with Disc Protrusion of L5-S1 and Canal Stenosis at L4-S1	5243	20%	Degenerative Disk Disease of the Lumbar Spine	5242	20%	20100122	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Low Back Pain with Disc Protrusion of L5-S1 and Canal Stenosis at L4-S1.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s back condition began in October 2007 after pushing heavy equipment.  Lumbar spine X-rays on 5 October 2007 were negative.  An MRI on 21 December 2007 showed disc bulging at L4-5 and to a lesser extent at L5-S1 with central disc protrusion at both L4-5 and L5-S1, multilevel ligamentum flavum hypertrophy (inflammation-related scar tissue of the ligament that connects the vertebrae), and central spine canal stenosis at L5-S1.  She was referred to orthopedics, but there was no surgical indication at that time.  The CI was treated conservatively with physical therapy, a muscle relaxer, nonsteroidal anti-inflammatory drugs, and pain medication.  The CI deferred when offered epidural steroid injections.  Thoracolumbar range of motion (ROM) measurements performed by physical therapy on 27 August 2008, 10 months prior to separation, showed flexion of 60 degrees (normal 90) and combined ROM of 210 degrees (normal 240) after repetition with pain on flexion and left rotation.   

The 16 October 2008 MEB NARSUM examination, 8 months prior to separation, noted complaints of pain and muscles spasms.  Physical examination showed a normal gait.  There was no tenderness.  Pain was noted with flexion and extension, but actual measurements were not provided.   Straight leg testing (to determine nerve root irritation) was negative.  

At the 25 January 2010 VA Compensation and Pension (C&P) examination, 7 months after separation, the CI reported daily low back pain, rated 8/10, which increased with twisting activities, prolonged sitting, and standing more than 20 minutes.  The pain occasionally radiated to both lower extremities, especially the thighs.  Physical examination showed normal lumbar spine alignment, minimal tenderness, and no muscle spasms.  Gait was normal.  ROM measurements were flexion 60 degrees and a combined ROM of 170 degrees after repetition, without pain.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back pain condition 20%, coded 5243 (intervertebral disc syndrome), citing active flexion of 58 degrees.  The VA also rated the low back pain condition 20%, coded 5242 (degenerative arthritis of the spine), based on the C&P examination, citing forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees.  The panel agreed that a 20% rating, but no higher, was justified for limitation of flexion (greater than 30 degrees but not greater than 60 degrees) as reported on the PT and VA examinations.  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 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 20170225, 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 Ms. XXXXXXXXXXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-02347.

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,

		

								

Attachment:
Record of Proceedings