RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03325
BRANCH OF SERVICE:  Air Force	SEPARATION DATE:  20060912

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Security Forces Journeyman, medically separated for “back pain” with a disability rating of 20%.  

CI CONTENTION:  “Every day I have more and more problems, it’s getting harder to work.”  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 - 20060801	VARD - 20061221	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Back Pain 	5239	20%	Lumbar Spondylosis 	5239	20%	20061212	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Back Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent corrective surgery, involving spinal fusion, bone graft and hardware placement in November 2004.  Post-surgery recovery was slow, and in January 2006, the CI underwent a second surgical procedure.  The 7 June 2006 MEB NARSUM examination, 3 months prior to separation, noted complaints of low back pain with right leg radiculopathy.  Physical examination showed he had “full back extension” during range of motion (ROM) testing.  Gait, coordination, and neurological findings were unremarkable.  The 19 July 2006 physical therapy (PT) ROM evaluation, 2 months prior to separation, documented flexion of 40 degrees (normal 90) and extension of 10 degrees (normal 30), using an inclinometer.

At the 12 December 2006 VA Compensation and Pension (C&P) evaluation, 3 months after separation, the CI reported his back condition had improved since his last surgery, but he was still symptomatic.  Physical examination of the lumbar spine found pain-free motion with flexion of 60 degrees (normal 90) and combined ROM of 210 degrees (normal 240).  The examiner noted there was no loss of motor function in the lower extremity but there was some sensory loss on the right lower extremity. 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 20%, coded 5239 (spondylolisthesis or segmental instability).  The VA also rated the back condition 20%, coded 5239, based on the C&P examination, citing forward flexion of 60 degrees.  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 VA and PT examinations.  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 back condition.   

BOARD FINDINGS:  In the matter of the back condition and IAW VASRD §4.71, 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 20170509, 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-2017-03325.

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