RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-04101
BRANCH OF SERVICE:  air force	SEPARATION DATE:  20071105

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

CI CONTENTION:  In addition to the back condition, the CI also requested review of additional conditions not identified by the Medical Evaluation Board (MEB) and 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’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 - 20070919	VARD - 20080529	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5237	10%	Chronic Lumbar Strain	5237	20%	20080211	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI was first seen for low back pain (LBP) on 23 November 2004 after riding horses.  She aggravated it 5 months later after lifting heavy equipment and in March 2006 was rear-ended with resultant LBP.  She became pregnant and received duty restrictions.  Following delivery, she was seen in a spine clinic on 1 May 2007 and reported ongoing LBP.  Physical examination revealed some limitation in motion due to pain.  X-rays were normal.

The 9 May 2007 MEB NARSUM examination, 6 months before separation, noted complaints of ongoing LBP.  Physical examination showed a normal gait and strength.  Back range of motion (ROM) was not recorded.  An MRI 3 weeks later was remarkable only for left scoliosis.  Physical therapy, on 12 July 2007, 4 months before separation, noted a relatively normal gait.  The ROM study showed flexion of 50 degrees (normal 90) and combined ROM of 165 degrees (normal 240); painful motion, tenderness and spasm were present.  

During the 11 September 2007 MEB NARSUM examination 2 months prior to separation, the CI reported no pain on the pain scale and was in no acute distress.  The gait and neurological examination were normal.  Repetitive-thoracolumbar flexion was 90 degrees and combined ROM was 205 degrees (normal 240); painful motion was present.  At a pain management follow up appointment on 3 January 2008, 2 months after separation, physical examination showed spinal tenderness and painful motion, but the neurological examination was normal.  

At the 11 February 2008 VA Compensation and Pension (C&P) examination, 3 months after separation, the CI denied incapacitation but endorsed occasional LBP.  She had full flexion unless she bent repetitively.  Physical examination showed a normal gait.  She was able to get on and off the examination table and squat without difficulty. The neurological examination was normal.  Repetitive flexion was 55 degrees and combined ROM was 195 degrees; painful motion was present.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, coded 5237 (lumbosacral strain), citing normal strength and sensation of the lower extremities.  The VA rated the back condition 20%, also coded 5237, based on the C&P examination, citing limitation of flexion.

Although the physical therapy and VA examinations recorded flexion which supported a 20% rating, 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), as recorded by the preponderance of STR ROM examinations and the MEB NARSUM examination, 2 months prior to separation.  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 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 back condition.  

BOARD FINDINGS:  In the matter of the 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.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170420, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

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

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-04101.

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.

						Sincerely,

		

							

Attachment:
Record of Proceedings