RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-04332
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20081015

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was active duty E5, Security Forces Helper, Military Working Dog Handler, medically separated for “chronic low back pain [LBP] due to degenerative disc disease” with a disability rating of 10%.   

CI CONTENTION:  Review of all conditions requested.  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 - 20080829	VARD - 20090424	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic LBP	5243	10%	Myofascial Lumbar Syndrome with Intermittent Right Lower Extremity Radiculopathy	5235	20%	20081219	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Chronic LBP.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s back condition began of unknown etiology in March 2006 and was aggravated in July 2007 by bowling and again during dog training.  Physical therapy (PT), chiropractic treatment, epidural steroid injections, and acupuncture failed to provide pain relief and allow return to duty in the CI’s military specialty.  Radiographic studies performed on 6 July 2007 revealed degenerative changes in the lumbosacral spine associated with displacement of the S1 nerve root due to a large disc protrusion.  

At the 19 June 2008 MEB NARSUM examination, 4 months prior to separation, the CI’s chief complaint was “chronic lower back pain.”  The physical examination (PE) noted decreased spinal range of motion (ROM) due to tenderness in all directional planes.  There was also non-spastic muscular tenderness about the lumbar spine.  Peripheral strength and reflexes were normal.  

At the 19 December 2008 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported stabbing pain in his low back, exacerbated by standing, sitting and walking.  There were no periods of flare-ups, bowel or bladder incontinence, or incapacitating episodes within the previous 12 months.  The examiner noted, “He is about to begin a job with the prison system, therefore, there is no effect on his occupation.”  His PE revealed a normal gait.  Mid-lumbar tenderness without spasm was present.  Lower spine ROM was recorded as forward flexion to 45 degrees with pain throughout and combined ROM of 125 degrees.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, coded 5243 (intervertebral disc syndrome [IVDS]).  The VA rated the back condition 20%, coded 5235 (vertebral fracture or dislocation), based on the C&P examination, citing forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees.  Panel members considered and ultimately agreed that the 2-month post-separation VA examination be apportioned the greatest degree of probative value due to its closeness to separation as well as being the most clinically detailed in its physical findings.  The panel agreed that a 20% rating, but no higher, was justified for limitation of spinal flexion (greater than 30 degrees but not greater than 60 degrees) as reported on the most probative examination.  There was no documentation of IVDS 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 chronic low back pain, 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 Pain	5243	20%	

The following documentary evidence was considered:

SAF/MRB

Dear XXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-04332.

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.