RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02505
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20070222

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a Reserve E5, Air Transportation Craftsman, medically separated for “chronic low back pain associated with sciatic pain; with degenerative disc disease and disc bulge at L3‑4” with a disability rating of 10%.

CI CONTENTION:  Review all conditions as well as additional conditions (cardiac, hypertension) not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB) was requested.  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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the (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 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 - 20070126	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain… 	5243	10%	No VA Examination Proximate to Separation in Evidence	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Chronic Low Back Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s low back condition began in July 2002 of unknown etiology and worsened over time.  Surgery was not recommended, and despite conservative treatment, to include, chiropractic care, physical therapy, medications, epidural injections and radiofrequency ablation, the CI was unable to continue serving in his specialty.  An MRI in April 2005 noted degenerative disc disease with minimal central prolapse at L3-4 and minimal osteoarthritic changes at L4-5. 

The 13 October 2006 MEB NARSUM examination, 4 months prior to separation, noted complaints of back pain that was tolerable when inactive or sitting, but worsened by impact activities or standing longer than 10 minutes.  The examiner documented lumbosacral spine range of motion (ROM) as forward flexion “to the level of the ankles,” extension to “approximately 20-30 degrees [normal 30],” trunk tilt (lateral flexion) to “approximately 20-30 degrees [normal 30]” bilaterally, and lateral rotation to “approximately 50-60 degrees [normal 30]” bilaterally.  Complaints of pain and soreness at the extremes was noted on all planes, but strength and reflexes were normal.  There was no VA examination proximate to separation in evidence

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, coded 5243 (intervertebral disc syndrome), citing forward flexion of the lumbosacral spine to the ankles (indicating greater than 60 degrees), and no neurological deficits despite lower extremity pain.  Panel members 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/or combined ROM (greater than 120 degrees but not greater than 235 degrees), as reported on the NARSUM 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.  While the CI may have suffered additional pain from the nerve involvement, this is subsumed under the general spine rating criteria, which specifically states “with or without symptoms such as pain (whether or not it radiates).”  There was no evidence in this case that motor weakness existed to any degree that could be described as functionally impairing.  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 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 20170315, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

SAF/MRB
3351 Celmers Lane
JBA NAF Washington, MD 20762-6435

Dear XXXXXXXXXX,

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-02505.

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 rating modification or re-characterization 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 modification of your disability rating or characterization of your separation is not warranted.  Accordingly, I accept the recommendation that your application be denied.

						Sincerely,

		

								

Attachment:
Record of Proceedings