RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-02932
BRANCH OF SERVICE:  Air Force	SEPARATION DATE:  20050408

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Fighter Aircraft Maintenance F-16 Journeyman, medically separated for “low back pain secondary to degenerative disk disease” with a disability rating of 20%.  

CI CONTENTION:  “Only my lower back was considered in the determination.  My middle back should have been evaluated and my hips.  Also my knees have gotten worse all due to my back.”  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 - 20050222	VARD - 20051207	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Low Back Pain… 	5243	20%	Degenerative Disc Disease, Lumbar Spine	5237-5243	10%	20050608	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Low Back Pain (LBP).  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s LBP began in March 2000 when he felt a "cracking" in his lower spine and immediate pain while lifting a heavy toolbox.  Physical therapy and nonsteroidal anti-inflammatory medications provided no relief.  On 5 February 2004, an MRI revealed degenerative discs at T11-T12 (bulging disc), L2-L3 (circumferential bulging), and L4-L5 and L5-S1 (slight bulging).  At L5-S1, the bulging disc was greater on the left than the right, with a very slight mass effect on the left L5; however, the nerve root sleeve could not be excluded.  There were also minimal arthritic changes at L4-L5 and L5-S1.  

At the 29 March 2004 neurosurgery visit, 13 months prior to separation, the CI complained of thoracic and low back pain exacerbated by moving or being in one position for too long.  The thoracolumbar spine examination showed tenderness over the thoracic spine extending from the level below the scapula down into the lumbar area.  The CI was able to execute lumbar spine flexion and extension, but flexion was more painful than extension.  The examiner opined that there was marked intervertebral disc wear and tear throughout the thoracic and lumbar spine, and recommended an exercise program to strengthen the thoracolumbar muscles and ligaments since surgery was not recommended.  

During the 27 August 2004 neurology appointment, 8 months before separation, the CI reported back pain worsened by bending or twisting the wrong way, and relieved by moving slowly and lying down.  On examination, gait and station were normal, and lumbar muscles showed full range of motion (ROM) with no tenderness or spasms.  

At the 13 October 2004 neurology visit for a second epidural steroid injection, 6 months prior to separation, the CI stated the previous injection provided no pain relief but that his back pain, rated at 6-7/10, was tolerable.  The examiner noted “restrictive” lumbar ROM with pain especially during flexion.  During the third ESI on 8 December 2004, the CI reported very good pain relief following the previous injection, but that it was short lived.  Back pain was rated at 5-7/10, and the examiner noted improved lumbar ROM, but continued pain on flexion.  The 28 January 2005 MEB NARSUM examination, 3 months before separation, noted complaints of back stiffness and pain.  Physical examination showed full ROM in all planes, with pain, and tenderness in the mid and lower back with no paraspinal muscle spasms.  

At the 8 June 2005 VA Compensation and Pension (C&P) evaluation, 2 months after separation, the CI reported constant, stabbing pain which was non-radiating, moderate in intensity, and occurred along the left lower lumbar region.  He had associated stiffness and weakness in the lower back with flare-ups of non-radiating, very severe stabbing pain of the left lower lumbar area which occurred about once a month and was precipitated by turning to the left or bending forward.  He claimed the flare-ups lasted for about 6-7 hours and limited his mobility with bending and walking; the last episode was about a month prior to examination.  The pain was alleviated by laying down and resting and he was not taking medication for pain at the time of the appointment.  Physical examination showed a normal gait with no evidence of paraspinal muscle spasm or tenderness, or obvious spinal curvature deformity.  Measured ROM was forward flexion of 90 degrees (normal) and combined ROM of 230 degrees (normal 240), with mild pain elicited by flexion and extension and no further limitations with repetition.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the LBP condition 20%, coded 5243 (intervertebral disc syndrome).  The VA rated the LBP condition 10%, analogously coded 5237-5243, (lumbosacral strain-intervertebral disc syndrome), based on the C&P evaluation, citing pain on spinal motion.  Members agreed there was insufficient limitation of motion to support a 10% rating, and while a 10% rating was justified for the presence of painful motion and tenderness, this provided no benefit to the CI.  Additionally, there was no evidence of intervertebral disc syndrome which resulted in incapacitating episodes requiring physician-prescribed bed rest to warrant consideration of rating under the alternate VASRD formula for that condition.  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 LBP condition.  

BOARD FINDINGS:  In the matter of the 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 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

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Dear XXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-02932.

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.