RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-04914
BRANCH OF SERVICE:  Air force	SEPARATION DATE:  20090528

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Aerospace Propulsion Craftsman, medically separated for “chronic low back pain due to degenerative disc disease, status-post laminectomy ” 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 - 20081024	VARD - 20100326	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain…	5243	10%	Lumbosacral Spine Degenerative Spondylosis	5242	10%	20090915	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:

Chronic Low Back Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI initially developed low back pain with lifting in 2004.  A subsequent MRI diagnosed multilevel degenerative disc disease (L2-S1, significant protrusion at L3/4 and spondylosis at L4/5 contributing to spinal stenosis).  In March 2008, 14 months before separation, he underwent a laminectomy at L3/4, and post-operative STR entries documented an uncomplicated course, but limited success with controlling pain.  Various STR entries documented grossly normal to modestly limited range of motion (ROM) and painful motion, with a normal gait and normal spinal contour.  There was no STR documentation of more severe ROM limitation or incapacitating episodes after surgical recovery.  

The 18 August 2008 MEB NARSUM examination, 9 months prior to separation, documented “continued lower back pain that is worse with most activities, especially running … and [the CI] is restricted in his duties at work.”  The physical examination recorded a normal gait, no spasm or tenderness, “subjective pain with any motion,” and normal neurological findings.  The NARSUM referenced formal ROM measurements performed by physical therapy (PT) on 9 May 2008.  These were charted as flexion to 65 degrees (normal 90) with a combined ROM of 200 degrees (normal 240), specifying painful motion.

At the 15 September 2009 VA Compensation and Pension (C&P) joint examination, 4 months after separation, the CI reported constant low back pain, rated at 7/10, that limited standing to 15-20 minutes and walking to “a couple of blocks.”  The physical examination recorded a well-healed non-tender surgical scar and the absence of spasm (a general C&P examination 5 days earlier had recorded a normal gait).  Measured ROM was flexion to 70 degrees with a combined ROM of 210 degrees, specifying pain at end ranges.  

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), referencing the PT flexion and specifying application of the VASRD.  The VA also rated the condition 10%, coded 5242 (degenerative arthritis of the spine), referencing the C&P flexion and citing the applicable VASRD §4.71a criterion.  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), as reported in the MEB PT and VA examinations most proximate to separation.  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 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 lumbar condition.

BOARD FINDINGS:  In the matter of the chronic low back pain 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.  

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

XXXXXXXXXX
XXXXXXXXXX
XXXXXXXXXX

Dear XXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-04914.

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.

						Sincerely,