RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02617
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20080219 

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Voice Network Systems Journeyman, medically separated for “chronic low back pain with bilateral L5 spondylolisthesis and mild anterolisthesis of L5 vertebral body” with a disability rating of 10%.   

CI CONTENTION:  “This rating should be increased to the current 60% disability rating from the VA.  The 10% rating did not sufficiently address the impact of the sustained injuries.”  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:  

PEB - 20071219	VARD - 20080619	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain…	5239	10%	Low Back Spondylolisthesis	5239	10%	20080319	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30% 	

ANALYSIS SUMMARY:  

Chronic Low Back Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s low back pain began in March 2006 while rucking with a 90-pound pack during tactical air control party training.  Magnetic resonance imaging (MRI) of the lumbar spine in May 2007 showed bilateral spondylolysis (stress fractures) with mild anterolisthesis (slippage) of the lumbar sacral vertebral body, and moderate neuroforaminal narrowing.  

The 15 November 2007 MEB NARSUM examination, 3 months prior to separation, noted CI complaints of pain, with radiation to the left leg and foot at times, and worsening with prolonged standing, lifting, running, and twisting.  Physical examination showed lumbar tenderness but normal mobility and thoracic spine appearance.  The examiner referred to range of motion (ROM) measurements performed by physical therapy on 13 November 2007, which showed flexion of 80 degrees (normal 90) and combined ROM of 160 degrees (normal 240) after repetition, with pain at the limit of motion with forward flexion.  Bilateral straight leg raise testing was negative, and deep tendon reflexes were 2+ and equal at the patellar and Achilles tendon.  

At the 19 March 2008 VA Compensation and Pension (C&P) evaluation, 1 month after separation, the CI reported constant pain but no flare ups.  He could not run because of burning, searing pain that radiated to his left leg after less than a block.  Physical examination showed a normal gait but lumbar spine flattening, with thoracolumbar flexion of 90 degrees (normal) and combined ROM of 230 degrees (normal 240) after repetition and associated with painful motion.  Neurologic findings were intact.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back condition 10%, coded 5239 (spondylolisthesis or segmental instability), citing Department of Defense and VARDs guidelines.  The VA also rated the low back condition 10%, coded 5239, based on the C&P evaluation, citing combined ROM of 220 degrees due to pain.  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 combined ROM (greater than 120 degrees but not greater than 235 degrees), as reported on the NARSUM and C&P examinations. 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.  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 low back condition.  

BOARD FINDINGS:  In the matter of the chronic low back pain 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 20170312, 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-2017-02617.

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