RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-03202
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20090426

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty, E5, Aircraft Structural Maintenance Craftsman, medically separated for “chronic low back pain” with a disability rating of 10%.  

CI CONTENTION:  “At the time of my Med Board I had a lot more issues that wasn’t addressed.”  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 – 20090116	VARD – 20090619	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain 	5299-5239	10%	Thoracic/Lumbar Dextroscoliosis/Strain	5242	20%	20090430	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI was first seen for a 2-week history of atraumatic back pain on 5 September 2007.  Thoracolumbar motion was normal but painful.  The neurological examination and gait were normal.  Radiographic studies showed 40 degrees of thoracic dextro-scoliosis between T7 and T12.  This was confirmed on a spine series (for scoliosis) and an MRI.  A neurosurgery evaluation on 6 February 2008 noted a normal gait and neurological examination.  The CI easily ascended the examination table (implying minimal impairment).  His condition was not thought to be amenable to surgical correction.  

The 9 July 2008 MEB NARSUM examination, 9 months prior to separation, noted complaints of chronic back pain.  Physical examination showed a notable left paraspinal elevation when compared to the right.  There was tenderness and significant pain with flexion.  There were no range of motion (ROM) measurements recorded and the neurological examination was intact.  In physical therapy on 11 September 2008, 8 months prior to separation, flexion was 95 degrees (normal 90) and combined ROM was 240 (normal) degrees, but painful.  It was noted that the CI made maximal effort and facial grimacing was observed.  At the orthopedic clinic appointment on 2 October 2008, X-rays showed thoracolumbar scoliosis with a 30 degree thoracolumbar curve.  At the 18 February 2009 separation physical a dextroscoliosis of 38 degrees was reported.  

During the 30 April 2009 VA Compensation and Pension (C&P) examination, 4 days after separation, the CI reported constant 10/10 low back pain, but denied incapacitation.  The CI also reported no limitations in activities such as gardening and pushing a lawn mower.  Physical examination showed normal gait, posture and neurological examination without muscle spasms or tenderness.  The Thoracolumbar ROM study showed flexion of 45 degrees and combined ROM of 175 degrees.  Both flexion and extension measurements stopped at the onset of pain.  Neither lateral bending nor rotation were painful.  There was no additional limitation in motion after repetitive use.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, analogously coded 5299-5239 (spondylolisthesis or segmental instability).  The VA rated the back condition 20%, coded 5242 (degenerative arthritis of the spine) based on the C&P examination, citing thoracolumbar flexion of 45 degrees.  The joint function was not additionally limited after repetitive use.  The panel majority noted the limitation of thoracolumbar motion recorded in the MEB NARSUM examination met the threshold for a 10% rating.  However, the VA examination proximate to separation was more detailed and reported ROM performed after repetitive motion.  Therefore the panel majority placed greater probative value on the VA examination.  The panel majority 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 VA examination.  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 the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 20% for the back condition, coded 5239.  

BOARD FINDINGS:  In the matter of the back condition, the panel majority recommends a disability rating of 20%, coded 5239 IAW VASRD §4.71a.  The single voter for dissent recommends no change but does not elect to submit a minority opinion.  There are no other conditions within the panel’s scope of review for consideration.  

The panel recommends the CI’s prior determination be modified as follows, effective the date of medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Low Back Pain 	5239	20%	

The following documentary evidence was considered:

SAF/MRB

XXXXXXXXXX
XXXXXXXXXX
XXXXXXXXXX

Dear XXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-03202.

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 not appropriate under the guidelines of the Veterans Affairs Schedule for Rating Disabilities.  Accordingly, the Board recommended modification of your assigned disability rating without re-characterization of your separation with severance pay.

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding, accept their recommendation and direct that your records be corrected as set forth in the attached copy of a Memorandum for the Chief of Staff, United States Air Force.  This will not result in any change to your separation documents or the amount of severance pay you are entitled to.  Disability severance pay is computed the same regardless of a rating of 0, 10 or 20 percent.