RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-04178
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20060324

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Communications, Navigation & Mission Craftsman, medically separated for “chronic low back pain” with a disability rating of 0%. 

CI CONTENTION:  “Condition has worsened since discharge. Neuropathy was never evaluated.”  The complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The panel’s scope of review is defined, may remain eligible for future consideration by the Board for Correction of Military Records 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.  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 - 20060206	VARD - 20070918	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain 	5243	0%	Degenerative Disc Disease (DDD), Lumbar Spine	5242	20%	20061121	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Low Back Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s back condition was longstanding with pain on and off for 8 years, without a history of trauma.  Left sided sciatica developed during pregnancy.  An MRI in May 2004 showed DDD at L4-L5 and L5-S1 with mild displacement of the L5-S1 left nerve root.  Neurosurgery consult recommended conservative measures.  At the 7 December 2005 orthopedic examination, 4 months prior to separation, the CI reported constant back pain with occasional left leg pain.  Physical examination showed a normal gait, but there was tenderness.  During range of motion (ROM) testing, the examiner noted the CI was able to forward flex to her toes and had normal extension and lateral bending.  Motor strength, reflexes and sensation were normal and examination maneuvers to elicit radicular symptoms were negative.  The CI was able to heel and toe raise without difficulty.  Surgery was not recommended.  The 10 January 2006 MEB NARSUM examination, 2 months prior to separation, noted good pain control as long as the CI limited her physical activity.  Physical examination showed a steady gate with normal muscle strength, reflexes and sensation.  ROM measurements were not provided.  

At the 15 February 2006 pain management consult, 1 month before separation, the CI reported lumbar facet injections had helped reduce her pain by nearly 100%, but the low back pain would gradually return.  Physical examination noted the CI was in no acute distress and her gait and spinal curvatures were normal.  Lumbosacral ROM was noted to be quite limited with lateral rotation and extension; however, no actual measurements were provided.  Examination maneuvers to elicit radicular symptoms were positive bilaterally.  Movements to provoke facet joint related pain were positive.  Testing for sacroiliac joint pain was positive bilaterally.  Lumbosacral paraspinals were taut and tender, but without discrete trigger points.

At the 21 November 2006 VA Compensation and Pension (C&P) examination, 8 months after separation, the CI reported constant low back pain and twice a week she had radiating pain with numbness and weakness in her right leg.  Physical examination showed a mildly antalgic gait with tenderness along the lower paraspinal muscles at L5-S1.  There was no muscle spasm.  Back ROM was flexion of 45 degrees (normal 90) and combined ROM of 185 degrees (normal 240) all associated with painful motion.  The CI was barely able to do repetitive motion testing; she grimaced and held on to the table when asked to do repetitive motion.  The examiner did not comment on ROM changes with repetition.  Lumbar spine X-rays showed mild DDD and spinal arthritis changes.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 0%, coded 5243 (intervertebral disc syndrome).  The VA rated the back condition 20%, coded 5242 (degenerative arthritis of the spine), based on the C&P examination, citing flexion of 45 degrees with pain.  The panel placed greater probative value on the VA examination because it was more detailed and compliant with VASRD rating guidelines.  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 VA examination.  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 recommends a disability rating of 20% for the back condition, coded 5243.  

BOARD FINDINGS:  In the matter of the 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 	5243	20%	

The following documentary evidence was considered:

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

Dear XXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-04178.

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.