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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-2017-04760.

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.

						

RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-04760
BRANCH OF SERVICE:  Air Force	SEPARATION DATE:  20050815

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Security Forces Craftsman, medically separated for “chronic low back pain” with a disability rating of 10%.  

CI CONTENTION: Review requested of additional conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB).  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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the 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 - 20050623	VARD - 20060109	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5243	10%	Degeneration of Lumbar Intervertebral Disc at L5-S1	5242	10%	20051028	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain (LBP).  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s low back condition began in August 2001 after hiking with a heavy pack.  He was treated conservatively with anti-inflammatories, muscle relaxants and physical therapy (PT), but in April 2003, he reported continued back pain with occasional leg paresthesia.  A lumbar spine MRI revealed an L5-S1 bulge without impingement.  At the 21 January 2005 MEB NARSUM examination, 7 months prior to separation, the CI reported continued LBP despite conservative treatment.  Physical examination showed a normal gait, and spinal tenderness without muscle spasms.  During the 3 March 2005 MEB PT evaluation, there was decreased lumbosacral lordosis, but no muscle spasm.   The provider documented “lumbosacral” active flexion to 75 degrees (normal 90), and combined ROM was at least 195 degrees (normal 240).  Extension and painful motion were not addressed.

At the 28 October 2005 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported constant, sharp LBP that did not radiate, but was associated with weakness, fatigability and lack of endurance.  He denied episodes of LBP that were intractable or required physician prescribed bedrest.  The examiner noted a slow gait and tenderness, but no muscle spasms or deformities.  Thoracolumbar spine flexion was to 80 degrees and combined ROM was 205 degrees, with painful motion, but no ROM loss after repetition.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back condition 10%, coded 5243 (intervertebral disc syndrome (IVDS)), citing limitation of flexion or combined ROM.  The VA also rated the low back condition 10%, coded 5242 (degenerative arthritis of the spine), based on the C&P examination, citing limitation of flexion.  Panel members agreed that a 10% rating, but no higher, was justified for limitation of flexion (greater than 60 degrees but not greater than 85 degrees) and/or combined ROM (greater than 120 degrees but not greater than 235 degrees), as reported on MEB PT and VA ROM examinations.  There was no muscle spasm or guarding severe enough to result in an abnormal gait or spinal contour, thus the next higher 20% rating was not justified on this basis.  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 concluded there was insufficient cause to recommend a change in the PEB adjudication for the LBP 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: