RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-04152
BRANCH OF SERVICE:  AIR FORCE 	SEPARATION DATE:  20060403

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Security Forces Journeyman, medically separated for “low back pain (LBP) associated with degenerative disc disease (DDD)” with a disability rating of 20%.    

CI CONTENTION:  He was given a higher rating by the VA for his back condition.  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 - 20060214	VARD - 20060803	
Condition	Code	Rating	Condition	Code	Rating	Exam	
LBP associated with DDD	5243	20%	Multilevel DDD of the Lumbosacral Spine	5243	40%	20060519	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  80%	

ANALYSIS SUMMARY:  

LBP associated with DDD.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), in September 2001 the CI experienced back pain that went away without treatment.  In October 2003 he developed a pinching sensation in his back when he stood up after bending over to pick up laundry.  He sought treatment and was given aspirin; no X-rays were taken.  In December 2004 the CI presented for worsening LBP for one year, denying trauma.  MRI studies on 21 December 2004 showed mildly hypertrophic facet joints throughout the lumbar region.  There was a small generalized disk bulge at L4-5 and L5-S1.  There was severe left foraminal stenosis in conjunction with some mildly hypertrophic facet joints with mild right neural foramen compromise.  The CI was referred to neurosurgery where he was found not to be a surgical candidate.   

The 3 January 2006 MEB NARSUM examination, 3 months prior to separation, noted complaints of constant LBP, worse with prolonged sitting and standing.  Despite physical therapy, chiropractic care, epidural and facet injections, and multiple medications, the CI had limited success in relieving his pain.  Physical examination showed no muscle spasms with a mildly stiff gait.  The examiner noted the CI was in mild distress.  There was no tenderness, increased warmth or erythema.  “Lumbar” range of motion (ROM) was to about 40 degrees. Measurements to determined combined ROM were incomplete (no rotation measurements).  EMGs were within normal limits.

At the 19 May 2006 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported constant severe LBP which limited his ability to sit or stand for longer than 15 minutes or lift more than 15-20 pounds.  He denied any incapacitating episodes.  The examiner noted the CI was in no acute distress.  Gait was mildly antalgic, with no muscle spasms swelling, effusion, or tenderness.  Strength was normal.  Examination of the “lumbosacral spine” revealed well developed muscles with good symmetry of movement and no deformities.  ROM was flexion of 20 degrees and combined ROM of 130 degrees with complaints of extreme pain.  Nerve conduction studies were normal.  The examiner stated it did not appear the CI participated at full capability.  The CI stated he wanted to prevent additional injury.  There was no loss of motion with repetitive use.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 20%, coded 5243 (intervertebral disc syndrome [IVDS]), citing VASRD guidelines.  The VA rated the back condition 40%, coded 5243, based on the C&P examination, citing forward flexion of the thoracolumbar spine of 30 degrees or less.  The NARSUM examiner specified the ROM for the lumbar spine, and not the thoracolumbar spine specified by the VASRD (§4.71a, Plate V).  The lumbar spine ROM was reported as 40 degrees of flexion.  Normal isolated lumbar flexion is 60 degrees. The VA C&P examination reported “lumbosacral spine” ROM.  The panel therefore concluded the C&P examiner reported lumbosacral ROM without the inclusion of thoracic motion. The panel also considered the C&P examiner’s comment regarding the CI not “participating at full capability.”  Members agreed that refusal to attempt spine excursion to full painful limits does not meet an acceptable standard for a ratable measurement.  Also, the ROM values based on subjective pain responses were not consistent with the objective absence of spasm, tenderness or abnormal contour which was documented in the same C&P examination.  There was no evidence of IVDS which resulted in incapacitating episodes requiring physician-prescribed bed rest to warrant consideration of rating under that alternate VASRD formula.  Therefore, based on all evidence and the associated conclusions just elaborated the panel concluded there was no evidence to support a rating higher than that adjudicated by the PEB.  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.    

The following documentary evidence was considered:

SAF/MRB

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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-2017-04152.

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.