SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD 20762

XXXXXXXXXX
XXXXXXXXXX
XXXXXXXXXX

Dear XXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-03447.

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.

						 

RECORD OF PROCeediNGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-03447
BRANCH OF SERVICE:  air force	SEPARATION DATE:  20060308

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, F-16 Avionics Systems Craftsman, medically separated for “chronic low back pain” with a disability rating of 10%.

CI CONTENTION:  Review all conditions.  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 - 20051206	VARD - 20061129	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5299-5242	10%	Lumbosacral Spondylolysis	5242	20%	20060226	
Neck Pain	Cat II	Cervical Spine Strain	5237	10%		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:

Chronic Low Back Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI had a history of chronic low back pain with bilateral lower extremity (BLE) radiation that was aggravated by a vehicular accident in July 2005.  Imaging (X-ray, MRI) demonstrated mild degenerative changes and multilevel disc disease at L1-5 and “minimal” neural impingement.  Multiple neurological examinations were normal with no contrary findings; serial electrodiagnostic studies (EMG) were negative for spinal radiculopathy; and, neurosurgery opined that surgery was not indicated.  Multiple STR entries noted grossly normal or non-specifically decreased range of motion (ROM), with none that suggested any significantly severe limitation.  Multiple STR entries documented normal gait and spinal contour, with no evidence to the contrary.  There was no STR documentation of intervertebral disc syndrome or incapacitating episodes.  

The 27 October 2005 MEB NARSUM examination, 5 months prior to separation, documented nonspecific low back pain with BLE radiation and no mention of subjective weakness, sensory complaints.  An L4 profile prohibited running and repetitive bending with limitation of prolonged standing or walking.  The physical examination recorded a normal gait without note of abnormal spinal contour, tenderness or spasm, and normal neurological findings (5/5 motor, symmetric reflexes, intact sensory).  The examiner recorded “mild decreased ROM...without pain.”  

At the 26 June 2006 VA orthopedic Compensation and Pension (C&P) examination, 4 months after separation, the CI reported “daily” low back pain rated 7/10, with BLE radiation and numbness, that prohibited running and sports.  The physical examination recorded a normal gait and no spasm but there was paraspinal tenderness.  Neurological findings were normal (5/5 motor, symmetric reflexes and intact sensory).  Measured thoracolumbar ROM was flexion to 55 degrees with a combined ROM of 185 degrees, noting pain at end-range and no ROM degradation with repetition.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, coded analogously as 5242 (degenerative arthritis of the spine), citing mild ROM limitation.  The VA rated the back condition 20%, coded 5242, citing limited flexion of the lumbosacral spine.  

The panel noted that the only formal ROM evidence compliant with VASRD §4.46 (accurate measurement) was that from the C&P examination, which was temporally probative to separation.  The panel acknowledged that the measured ROM by the VA examiner was somewhat incongruent with the observed ROM evidence from the STR.  Members agreed, however, that the C&P findings should be assigned the determinant probative value, given the imperative to comply with VASRD rating guidance and the lack of any compelling evidence to refute those findings.  The panel thus 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 recorded in the C&P examination.  There was no evidence of intervertebral disc syndrome with incapacitating episodes to support a higher rating under that formula.  After due deliberation, considering all the evidence and conceding VASRD §4.3 (reasonable doubt), the panel recommends a 20% rating for the back condition under code 5242.

Contended PEB Condition:  Neck Pain.  The panel’s main charge is to assess the fairness of the PEB determination that the contended condition was not unfitting.  This condition, consisting of radiating neck pain and later arm/hand sensory complaints, first surfaced in 2004 while doing sit-ups.  There was no significant neurological pathology identified by MRI or EMG.    The condition was not profiled, implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that it significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for the neck condition, so no additional disability rating is recommended.

BOARD FINDINGS:  In the matter of the back condition, the panel recommends a disability rating of 20%, coded 5242 IAW VASRD §4.71a.  There are no other conditions within the panel’s scope of review for consideration.  In the matter of the contended neck condition, the panel recommends no change from the PEB determination as not unfitting.  

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	5242	20%