RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-04588
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20090728

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Aerospace Ground Equipment Journeyman, medically separated for “low back pain” with a disability rating of 20%.  

CI CONTENTION:  “Still have loss of range of motion standing and being on my feet for more than 1-2 hours at a time puts me in back and nerve pain.  Preventing me from working a full time job.”  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 - 20090427	VARD - 20091211	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Low Back Pain, Status Post (S/P) L4-5 Microdiscectomy	5243	20%	Residuals, S/P Lumbar Spine Surgery with Asymptomatic Postural Kyphosis	5242	20%	20091023	
Morbid Obesity	Cat III	No VA Placement	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Low Back Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent back surgery with L5-S1 microdiscectomy in May 2007 for a herniated disc.  X-rays of the lumbar spine on 9 April 2008 revealed normal alignment, and normal vertebral body height and disc space.  No spondylolysis was appreciated.  The facets had a normal appearance and bones and soft tissues were normal.  At the time of the physical therapy (PT) clinic appointment on 28 July 2008, 12 months prior to separation, the CI reported low back pain (6/10) that radiated to the bilateral hips.  On examination there was no muscle spasm.  Lumbosacral spine range of motion (ROM) showed flexion of 20 degrees (normal 60), extension of 20 degrees (normal 30) and lateral flexion of 15 degrees (normal 30) bilaterally.  Straight leg raise (SLR) testing was positive.  

The 22 January 2009 MEB NARSUM examination, 6 months prior to separation, noted complaints of back stiffness diffusely in the morning.  This did not seem to decrease throughout the day.  She had a clicking sensation in the lower back and denied any radicular pain.  Physical examination showed the CI had a negative SLR test.  Thoracolumbar ROM showed flexion limited to 45 degrees (normal 90) and extension limited to 15 degrees.  Rotation side-to-side was intact.  The next day, lumbosacral spine ROM measurements performed by PT showed flexion of 10 degrees and combined ROM of 105 degrees after repetition.  

At the 23 October 2009 VA Compensation and Pension (C&P) examination, 3 months after separation, the CI reported moderate pain in the low back when standing for extended time with occasional radiation down to the bilateral hips, and the posterior right thigh to the posterior knee.  Physical examination showed the CI walked with a normal gait.  Strength was 5/5 and deep tendon reflexes were 2+.  There was no muscle spasm, guarding or localized tenderness.  Thoracolumbar ROM showed flexion of 50 degrees and combined ROM of 190 degrees (normal 240).  There was no painful motion noted.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back condition 20%, coded 5243 (intervertebral disc syndrome [IVDS]).  The VA also rated the low back condition 20%, coded 5242 (degenerative arthritis of the spine), based on the C&P examination, citing flexion of the thoracolumbar spine that is limited to 50 degrees.  

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 MEB NARSUM and VA C&P examinations proximate to separation.  There was no documentation of IVDS with incapacitating episodes which would provide for a higher rating under that formula.  The panel noted the 28 July 2008 and 23 January 2009 PT examinations reported “lumbosacral spine” ROM, and further noted these examinations occurred prior to the current VASRD guidelines that utilize combined thoracic and lumbar ROM.  The panel therefore concluded the PT examiners were reporting lumbosacral ROM without the inclusion of thoracic motion.  Therefore the panel placed greater probative value on the MEB NARSUM and C&P examinations.  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:  

	

XXXXXXXXX

Dear XXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-04588.

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.