RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03541
BRANCH OF SERVICE:  Air Force	SEPARATION DATE:  20050906

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

CI CONTENTION:  The requested a review of all conditions noting that his current rating should be higher.  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 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 - 20050718	VARD - 20060306	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic LBP with Bulge at L4-5 and Annular Tear of L5-S1	5243	10%	Degenerative Lumbar Disc, with Extrusion	5299-5242	10%	20060107	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Chronic LBP with Bulge at L4-5 and Annular Tear of L5-S1.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s low back condition began in April 2003 after heavy lifting while deployed to Saudi Arabia.  An MRI in October 2006 revealed L4-5 central disk herniation without significant compression or nerve root impingement, as well as a small annular tear in the L5-S1 disc.  Epidural steroid injections and conservative therapy did not provide sustained relief, and the specialist indicated the CI was not a surgical candidate.  

At the time of the pain management clinic appointment on 27 April 2005, 4 months prior to separation, the CI reported continued daily LBP.  Physical examination revealed “the LS [lumbosacral spine] range of motion [ROM] was preserved.”  There was no evidence of paraspinal muscle spam or tenderness.  The specialist indicated no more aggressive treatment was indicated.  

The 9 June 2005 MEB NARSUM examination, 3 months prior to separation, noted complaints of LBP and the inability to perform his primary occupation duties.  He could not do sit-ups and or run due to increased pain while running.  Physical examination revealed a normal gait.  There was tenderness in the lower lumbar region and “slight decreased ROM due to pain in all directions.”  

At the 7 January 2006 VA Compensation and Pension (C&P) examination, 4 months after separation, the CI reported daily low lumbar and left-side pain with occasional right posterior thigh pain which was dull with occasional sharp, shooting pains, and weakness that resulted in a fall a few weeks prior to the examination.  The CI reported incapacitation every 3-4 months that lasted 24-36 hours with flare-ups every month that could last 3-4 days.  Back pain was worse with activities, interfered with sleep, and he was not taking any medications.  Physical examination revealed no peripheral edema in his extremities.  Romberg, tandem and heel-to-toe walk were normal.  He was able to squat without difficulty and able to sit and rise from a chair using his upper extremities without difficulty.  The spine examination showed soft paraspinous muscles and mild loss of lordotic curve.  There was tenderness in the mid-lumbar region.  Thoracolumbar ROM was flexion of 90 degrees (normal) with pain noted, and combined ROM was 230 degrees (normal 240).  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back condition 10%, coded 5243 (intervertebral disc syndrome [IVDS]).  The VA also rated the low back condition 10%, analogously coded 5299-5242 (spinal fusion), based on the C&P examination, citing the VASRD ROM 10% rating criteria of forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or, combined ROM of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees.  

The panel agreed a 10% rating was justified for the presence of painful motion and/or tenderness noted on the preponderance of examinations.  There was insufficient limitation of motion to support any rating higher than 10%.  While the CI may have suffered additional radiating pain, this is subsumed under the general spine rating criteria, which specifically states “with or without symptoms such as pain (whether or not it radiates).”  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.  There was no documentation of IVDS which resulted in incapacitating episodes requiring physician-prescribed bed rest to warrant consideration of rating under the alternate VASRD formula for that condition.  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 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 XXXXXXXXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-03541.

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.