RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-04194
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20080623

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Personnel Apprentice, medically separated for “low back pain (LBP)” due to degenerative disc disease  (DDD)” with a disability rating of 10%.   

CI CONTENTION:  “Have had continued pain in back that has gotten worse over the years.”  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 - 20080505	VARD - 20081205	
Condition	Code	Rating	Condition	Code	Rating	Exam	
LBP due to DDD	5243	10%	 Lumbar Spine DDD	5237	20%	20081027	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

LBP due to DDD.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s low back condition began in December 2006 after being involved in a motor vehicle accident (MVA).  Painful symptoms were initially mild but worsened over time.  The physical therapy examination performed on 6 February 2008, 4 months prior to separation, documented thoracolumbar range of motion (ROM) of forward flexion to 80 degrees (normal 90) and combined ROM of 210 degrees (normal 240).  

The 4 March 2008 MEB NARSUM examination, 3 months prior to separation, noted complaints of back pain aggravated by prolonged standing and sitting.  The CI’s physical limitations included pushups, sit-ups, and lifting more than 20 pounds.  The physical examination (PE) was referenced from an examination performed on 11 December 2007, 6 months prior to separation, which noted no tenderness about the lumbar spine.  

The 6 October 2008 VA Compensation and Pension (C&P) general examination, 3 months after separation, revealed a normal gait.  At a VA examination at the end of the month the CI reported back pain without peripheral radiation.  Her pain was described as achy and variable in intensity.  The VA provider documented spinal ROM in a way that raised questions of its full understanding; inconclusively, it could be interpreted as 40 degrees of flexion. Additionally, there were missing values for bilateral lateral flexion measurements.  Local tenderness, guarding, painful motion, and abnormal spinal contour were present.  However, the examiner opined that the mild thoracolumbar scoliosis (abnormal spinal contour) was unlikely to be related to the CI’s past MVA, and probably was previously present and undetected.  There was no comment with regard to the CI’s gait.  Sensory, motor and peripheral reflexes were normal. 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the LBP due to DDD 10%, coded 5243 (intervertebral disc syndrome).  The VA rated the same condition 20%, analogously coded 5237 (lumbosacral strain) based on the C&P examination, citing forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees.  The panel agreed that if the questionable ROM value were concluded as being actually 40% as (possibly) reported by the VA examiner 4 months after separation then that measurement would be significantly worse than ROMs reported by pre-separation examinations.  There is no record of recurrent injury or other development to explain a more marked impairment as possibly reflected by the VA notes.  While ROM limitations may have progressed over time, there is no evidence in the record from which to conclude that the severity at or near separation approached that portrayed by the VA if it had been interpreted to be at 40 degrees.  

The panel majority agreed that the pre-separation examinations were more consistent with other outpatient notes and more reflective of the anticipated severity based on the clinical pathology. After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel majority agreed that all PEs conducted up through and to 3 months after separation did not support a 20% rating under the VASRD spinal guidelines.  Therefore, the panel majority concluded there was insufficient cause to recommend a change in the PEB adjudication for the LBP due to DDD.  

BOARD FINDINGS:  In the matter of the low back pain due to degenerative disc disease and IAW VASRD §4.71a, the panel majority recommends no change in the PEB adjudication.  The single voter for dissent recommends modification to 20% and did not elect to submit a minority opinion.  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
3351 Celmers Lane
JBA NAF Washington, MD 20762-6435

Dear XXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-04194.

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 rating modification or re-characterization 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 modification of your disability rating or characterization of your separation is not warranted.  Accordingly, I accept the recommendation that your application be denied.