RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03400
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20090629

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Vehicle and Vehicular Equipment Maintenance Journeyman, medically separated for “low back pain (LBP)” with a 10% disability rating.   

CI CONTENTION:  The CI contended for his worsening back pain and for post-traumatic stress disorder (PTSD) which was not identified by the Medical Evaluation Board (MEB) and/or Physical Evaluation Board (PEB). 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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the 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 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 - 20090414	VARD - 20100308	
Condition	Code	Rating	Condition	Code	Rating	Exam	
LBP	5003	10%	Lumbar Spine Degenerative Disc Disease 	5242	10%	20090829	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

LBP).  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s low back condition began in July 2006 without any specific injury or trauma.  Lumbar spine MRIs done in August 2006 and again in June 2007 revealed a moderate-sized disc protrusion at L4-5 with mild nerve root contact.  The CI was evaluated by neurosurgery and there was no surgical indication.  The CI decided against pain management treatment and epidural injections.  The 3 September 2008 MEB neurosurgery examination, 10 months prior to separation, noted complaints of continued LBP, graded 5/10, aggravated by standing and bending.  The CI related that his LBP had increased, but he did not have not have radicular symptoms.  He reported some occasional numbness in the entire upper leg and the posterior lower legs when his back pain was particularly strong.  Physical examination showed no tenderness.  Low back range of motion (ROM) was full in all measurements with no pain.  Straight leg raise (SLR) testing to elicit radicular symptoms was negative bilaterally.  

During the 22 December 2008 MEB NARSUM examination, 6 months prior to separation, the CI reported continued LBP.  Physical examination showed a normal gait.  There was tenderness over the lower spine and a negative straight leg raise (SLR) with pain in the lower back, but no lower extremity pain.  

At the 29 August 2009 VA Compensation and Pension (C&P) evaluation, 2 months after separation, the CI reported daily moderate LBP that radiated down both legs, aggravated by exercising, lifting and bending.  The CI reported flare-ups with overexertion.  He was not using any assistive devices for ambulation and there were no limitations with standing or walking other than pain.  Physical examination showed a normal gait.  There was no abnormal curvature of the spine and no tenderness, muscle spasm, weakness, guarding, or atrophy present.  Thoracolumbar ROM was flexion of 90 degrees and combined ROM of 190 degrees.  There was pain with motion and no additional limitation of motion with repetition.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back condition 10%, coded 5003 (degenerative arthritis), citing general DoD and VASRD guidelines.  The VA also rated the low back condition 10%, coded 5242 (degenerative arthritis of the spine), based on the C&P examination 2 months after separation, citing limitation of combined thoracolumbar ROM (greater than 120 degrees but not greater than 235 degrees).  

The panel agreed that a 10% rating, but no higher, was justified for limitation of flexion (greater than 60 degrees but not greater than 85 degrees) or combined ROM (greater than 120 degrees but not greater than 235 degrees), as reported on the VA examination, which was the most proximate to separation and was a more complete examination than the MEB NARSUM examination.  There was no muscle spasm or guarding severe enough to result in an abnormal gait or spinal contour, thus the next higher 20% rating was not justified on this basis.  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 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.  

SAF/MRB
3351 Celmers Lane
JBA NAF Washington, MD 20762-6435

Dear XXXXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-03400.

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.