RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02541
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20090901

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

CI CONTENTION:  The condition continues to worsen and he received a higher rating from the VA.  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 - 20090804	VARD - 20100929	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5243	20%	Degenerative Disc Disease, Lower Back	5242	NSC	20100302	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain (LBP).  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s back condition began in June 2006 without specific injury or trauma.  An MRI in April 2008 showed a disc herniation at L2-3 without nerve impingement and disc dryness (desiccation) from L2 through L5.  

At the 3 April 2009 MEB NARSUM examination, 5 months prior to separation, the CI endorsed severe cramping in his back and neck with light activity, and pains shooting into his legs leading to toe numbness.  Physical examination (PE) revealed a normal gait with low lumbar spine tenderness, but no mention of spasm or abnormal spinal contour.  Spinal range of motion (ROM) measurements were not provided.  

At physical therapy appointments on 26 May 2009 and 12 June 2009, the CI’s lumbar ROM was reported as “within normal limits,” but with lumbar spinal tenderness and painful motion.  The 20 July 2009 PT ROM study, 6 weeks before separation, noted flexion of 40 degrees (normal 90) and combined ROM of 165 (normal 240) after repetition.  A slight antalgic gait was present.  

The 2 March 2010 VA Compensation and Pension (C&P) evaluation, 5 months after separation, showed CI complaints of moderate back pain aggravated by physical activity, prolonged sitting, walking or standing.  He denied episodes of incapacitation in the previous 12 months.  On PE, gait and spinal contour were normal with no muscle spasm or guarding.  ROM testing showed flexion of 90 degrees and combined ROM of 240 degrees without pain. 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition at 20%, coded 5243 (intervertebral disc syndrome).  The VA determined the back condition was not service connected, citing the medical evidence failed to show the disability had been clinically diagnosed.  The panel agreed a 20% rating, but no higher, was justified for limitation of flexion greater than 30 degrees but not greater than 60 degrees, as reported at the 20 July 2009 PT ROM study.  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 back condition.  

BOARD FINDINGS:  In the matter of the chronic LBP 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 20170306, 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 XXXXXXXXXXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-02541.

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