RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-03783
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20050708

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Munitions System Journeyman, medically separated for “chronic low back” 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 - 20050427	VARD - 20060424	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5243	10%	Degenerative Disc Disease (DDD) of the Lumbar Spine	5242	20%	20050823	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain (LBP).  According to the service treatment record and MEB narrative summary (NARSUM), the CI injured her back in September 2003 while pulling a trailer at a work site.  An MRI revealed mild DDD at L5-S1 with broad-based bulging, but no central spinal stenosis.  An epidural injection with anesthetic (due to a steroid sensitivity) but did not provide any relief.  Repeat MRI results in January 2005 were similar to the prior MRI findings.  At an 8 February 2005 pain management examination, 5 months prior to separation, the CI reported chronic LBP mainly with axial and gluteal pain, but denied any radiculopathy or bowel/ bladder dysfunction.  Physical examination showed an antalgic gait, sacroiliac joint tenderness greater on the right than left, positive facet loading and paraspinal muscles tenderness.  She was able to heel-to-toe walk and straight leg raise testing to elicit radicular symptoms was negative.  Sensory and motor findings were normal.  She received a facet block, which did not alleviate the pain, and she declined a discogram.  The 16 March 2005 MEB NARSUM examination, 4 months prior to separation, noted CI complaints of chronic LBP despite extensive treatment modalities.  The examiner cited the February pain management findings.  An MRI on 7 June 2005, 1 month before separation confirmed mild DDD at L5-S1 with mild broad-based bulging without disc herniation.  

At the 23 August 2005 VA Compensation and Pension (C&P) examination, 1 month after separation, goniometric thoracolumbar range of motion (ROM) revealed flexion to 40 degrees (normal 90), and a combined ROM of 165 degrees (normal 240).  There was painful motion with flexion and extension, but no additional loss of motion with repetitive use.  

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)), citing general DoD and VASRD guidelines.  The VA rated the low back condition 20%, coded 5242 (degenerative arthritis of the lumbar spine), based on the C&P examination, citing forward flexion of 40 degrees and pain on ROM.  Panel members determined that the C&P examination carried the most probative for rating as it was closest to separation and included VASRD compliant thoracolumbar ROM measurements.   Thus, 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).  There was no documentation of IVDS with incapacitating episodes which would provide for a higher rating under that formula.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 20% for the low back condition, coded 5243  

BOARD FINDINGS:  In the matter of the low back condition, the panel recommends a disability rating of 20%, coded 5243 IAW VASRD §4.71a.  There are no other conditions within the panel’s scope of review for consideration.  

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	5243	20%	

The following documentary evidence was considered:

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

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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-2017-03783.

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.