RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-03041
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20080530

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Munitions Systems Journeyman, medically separated for “chronic low back pain [LBP] with central disc protrusion at L5-S1” with a disability rating of 20%.  

CI CONTENTION:  No contention was made.  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 - 20080401	VARD - 20090114	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic LBP with Central Disc Protrusion at L5-S1	5243	20%	Chronic Low Back Strain 	5237	40%	20081217	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Chronic LBP with Central Disc Protrusion at L5-S1.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s low back condition began in August 2006 after loading heavy bombs.  The CI reported LBP that radiated to the legs.  An MRI performed in September 2006 showed central disc protrusion at LS-S1, minimal deviation of the traversing right S1 nerve root, and no nerve root compression.  At an orthopedic examination on 21 December 2006, the CI reported LBP with radiation to the right buttock and occasional radiation to the groin.  Additional time and conservative treatment was recommended before considering surgery.  A follow-up MRI performed on 13 August 2007 revealed a stable central disc protrusion at LS-S1, impinging on the right S1 nerve root.  At an orthopedic examination on 9 October 2007, the CI reported continued LBP with radiation to the right lower extremity and an epidural steroid injection was recommended.  In October 2007, the orthopedic surgeon discussed treatment options with the CI of microdiscectomy or maximizing conservative treatment.  The undated commander’s statement indicated the CI had not lost a full day of work due to the back condition and had only missed time due to medical appointments.

At the 16 January 2008 physical therapy clinic appointment, 4 months prior to separation, physical examination showed thoracolumbar range of motion (ROM) was flexion of 50 degrees (normal 90) and combined ROM of 130 degrees (normal 240) with painful motion after repetition.  The MEB NARSUM examination 6 days later noted complaints of severe pain and restriction in ROM.  Physical examination showed thoracolumbar spine tenderness and muscle spasms with an abnormal posture.  There was abnormal and painful ROM and examination maneuvers to elicit radicular symptoms were positive.  The MEB NARSUM examiner noted the benefit of surgical intervention was equivocal.  

At an outpatient visit on 3 November 2008, 5 months after separation, the CI reported a history of herniated disks and right sciatica.  He reported he still had occasional 2/10 pain and occasional flare-ups with activity.  Physical examination showed a normal gait and tenderness of the bilateral sacroiliac joints and L5 area.  The bilateral lower extremities were normal.  A 7 November 2008 MRI showed posterior annular ligament (surrounds disc material) tear and disc bulge of LS-S1 disc without impingement on the nerve roots or central canal stenosis.  The provider noted that if the CI was not in pain, he would just monitor; and if the CI was in pain, he could be referred to neurosurgery for consultation as his insurance was going to expire soon.  

At the 17 December 2008 VA Compensation and Pension (C&P) examination, 7 months after separation, the CI reported continued LBP with radiation into the right lower extremity with symptoms of decreased motion, stiffness, spasms, and tingling.  He reported no treatment since discharge from the military since his insurance had expired and his back condition had gotten progressively worse.  The CI reported flare-ups weekly lasting 1 to 2 days.  He reported 20 totally incapacitating episodes in the past 12 months.  Physical examination showed lumbar flattening, muscle spasms, guarding and tenderness.  The examiner noted the CI had a stooped posture and antalgic gait.  Thoracolumbar ROM was flexion of 30 degrees and combined ROM of 130 degrees with painful motion after repetition.  Testing to elicit radicular symptoms was positive on the right.  Otherwise normal lumbosacral spine X-rays noted questionable early degenerative disc disease of the·fifth lumbar intervertebral space.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back condition 20%, coded 5243 (intervertebral disc syndrome [IVDS]).  The VA rated the low back condition 40%, coded 5237 (lumbosacral strain), based on the C&P examination, citing forward flexion of the thoracolumbar spine of 30·degrees or less.  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 MEB NARSUM examination.  Although the thoracolumbar ROM at the VA examination was significantly worse than at the MEB NARSUM examination, the November primary care examination after separation supports that the CI’s back condition was not as severe more proximate to the date of separation, and the panel concluded the VA examination reflected post-separation worsening.  The CI did have radiating pain to the right lower extremity due to IVDS, however, there was no evidence of incapacitating episodes prior to separation 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:

SAF/MRB

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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-2017-03041.

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.