RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX.	CASE:  PD-2017-04052
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20080519

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

CI CONTENTION:  “It is my belief that my service connected disability was more extensive than originally determined.”  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 - 20080402	VARD - 20080821	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Low Back Pain	5242	20%	Lumbar Strain	5237	20%	20080620	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Low Back Pain (LBP).  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s low back condition began in September 2005 after loading ammunition on an A-10 aircraft.  A 26 April 2006 MRI of the lumbar spine revealed partial sacralization of L5 with loss of L5/S1 transitional disk space and broad-based disk bulges at L2/3, L3/4 and L4/5.  He was treated conservatively with physical therapy, pain medications, chiropractic treatments, and steroid injections to the L5-S1 facet and trigger point with some slight improvement in his symptoms.  A 15 December 2007 MRI showed a transitional sacralized L5 vertebral body and rudimentary L5-SI disk.  The CI did not have any neurological deficit however he did not show any progress after 2 years of conservative therapy.  He was not a surgical candidate.  

At the 18 December 2007 physical therapy evaluation for MEB thoracolumbar range of motion (ROM) measurements, the CI had no specific complaints.  Flexion was 35 degrees after repetition (normal 90), with a combined ROM of 105 degrees (normal 240), all limited by pain.  The 22 February 2008 MEB NARSUM examination, 3 months prior to separation, noted complaints of continued LBP on a daily basis worsening throughout the day ranging from 3/10 to 7/10.  Physical examination showed lower back tenderness without muscle spasm.  The lumbar/lumbosacral spine exhibited decreased ROM secondary to pain on flexion and lateral rotation of the back.  Gait and reflexes were normal.  

At the 20 June 2008 VA Compensation and Pension (C&P) examination, one month after separation, the CI reported 6/10 constant aching LBP made worse with physical activity and bending.  Physical examination showed lumbar tenderness with muscle spasm and a normal posture and gait.  There was no radiating pain with movement.  Flexion was 55 degrees with a combined ROM of 205 degrees.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back condition 20%, coded 5242 (degenerative arthritis of the spine).  The VA also rated the low back condition 20%, coded 5237 (lumbosacral or cervical strain), based on the C&P examination, citing limitation of forward flexion.  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 both NARSUM and C&P examinations.  A higher evaluation of 40% is not warranted unless there is forward flexion of the thoracolumbar spine of 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine.  There was no documentation of intervertebral disc syndrome with incapacitating episodes which would provide for a higher rating under that formula.  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
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-2017-04052.

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.