RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-03255
BRANCH OF SERVICE:  Air force	SEPARATION DATE:  20080421

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 “low back pain (LBP) with radiculopathy due to spondylosis” with a disability rating of 10%.

CI CONTENTION:  The back condition continues to worsen and negatively impacts employment.  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 - 20080306	VARD - 20081114	
Condition	Code	Rating	Condition	Code	Rating	Exam	
LBP with Radiculopathy …	5242	10%	Lumbar Spine DDD	5242	10%	20081024	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:

LBP with Radiculopathy due to Spondylosis.  According to the service treatment record and MEB narrative summary (NARSUM), the CI experienced years of LBP which worsened after undergoing left knee surgery in January 2007.  A lumbosacral MRI performed in May 2007 revealed L5-S1 early degenerative changes and early degenerative disc disease (DDD).  At the 17 December 2007 MEB NARSUM examination, 11 months prior to separation, the CI reported constant bilateral LBP with occasional radiation to the left buttock.  He denied lower extremity (LE) weakness or numbness.  Physical examination showed a normal spine curvature; the CI sat leaning forward, and back tenderness was present.  Back flexion was 90 degrees (normal) and combined range of motion (ROM) was 230 degrees (normal 240).  Painful motion was not addressed.  Bilateral straight leg raise (SLR) tests for radiculopathy were negative. LE strength, reflex, and sensory testing was normal.  

At the 24 October 2008 VA Compensation and Pension (C&P) examination, 6 months after separation, the CI reported constant LBP.  He denied numbness, loss of bladder or bowel control, and incapacitation.  Physical examination revealed a normal gait and posture, and no spinal tenderness or muscle spasm.  Thoracolumbar spine flexion was 70 degrees and combined ROM was 180 degrees with painful motion with no ROM loss following repetition and no evidence of radiating pain. Bilateral SLR was negative and LE motor and sensory function, along with reflexes were normal.  A lumbar spine X-ray revealed S1 dysraphism (congenital back malformation) as an anatomical variant; otherwise there was proper lumbar spine alignment and no compression, subluxation, spondylosis (degenerative changes), or degenerative disc space narrowing.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB and the VA both rated the LBP condition 10%, coded 5242 (degenerative arthritis of the spine).  The PEB cited the VASRD IAW NDAA 2008.  The VA based the rating on the C&P examination, citing limitation of combined ROM.  The panel agreed that a 10% rating, but no higher, was justified for limitation of combined ROM (greater than 120 degrees but not greater than 235 degrees), as reported on the MEB NARSUM and VA ROM examinations.  There was no muscle spasm or guarding severe enough to result in an abnormal gait or spinal contour for the next higher 20% rating.  There was no evidence of intervertebral disc syndrome for a higher rating under that formula.  While the CI may have experienced radiating pain from the back condition, this is subsumed under the general spine rating criteria, which specifically states “with or without symptoms such as pain (whether or not it radiates).”  The panel noted there was no objective evidence of a radiculopathy with functional impairments (such as weakness) nor performance-based evidence from the record that this condition significantly interfered with satisfactory duty performance at separation.  The panel therefore concluded that an additional disability rating was not justified on this basis.  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 LBP condition.  

BOARD FINDINGS:  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 LBP condition.  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-2017-03255.

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.