RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX.	CASE:  PD-2017-04920
BRANCH OF SERVICE:  Air Force	SEPARATION DATE:  20081104

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 multi-level disc degeneration and disk protrusions at L3-4, L4-5, and L5-S1” with a disability rating of 10%.  

CI CONTENTION:  Review all conditions.  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 - 20080916	VARD - 20090113	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain…	5243	10%	Degenerative Disc Disease, Lumbar Spine	5242	10%	20081208	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain. According to the service treatment record and MEB narrative summary (NARSUM), the CI’s low back condition began in the winter of 1999 when the CI pulled a bag from the back of a truck with the tailgate up.  On 23 October 2007, X-rays showed degenerative disk and degenerative joint disease.  An MRI in November 2007 showed multi-level disk degeneration with disk protrusion at L3-4, L4-5 and L5-S1 levels, with the L5-S1 extrusion appearing to be touching the left S1 nerve root.  Despite anti-inflammatory medications, physical therapy, chiropractic and pain clinic management, the pain persisted.  
The 12 July 2008 MEB NARSUM examination, 4 months prior to separation, recorded CI complaints of intermittent radiculopathy to the right buttock and down the right leg.  No bowel or bladder symptoms were reported.  Physical examination noted difficulty getting up onto the examination table and tenderness over the lumbar paravertebral muscles bilaterally.  Range of motion (ROM) showed flexion of 75 degrees (normal 90) with painful motion and combined ROM of 225 degrees (normal 240).  

At the 8 December 2008 VA Compensation and Pension (C&P) examination, 1 month after separation, the CI reported moderate low back pain without radiation.  Physical examination showed normal posture and gait, and no spasm, atrophy, guarding, tenderness, weakness or abnormal spinal curvature.  Thoracolumbar ROM showed forward flexion of 70 degrees and combined ROM of 220 degrees, with no painful motion or additional loss following 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).  The VA also rated the back condition 10%, but coded 5242 (degenerative arthritis of the spine), based on the C&P examination, citing forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or combined ROM of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees.  Members agreed that a 10% rating, but no higher, was justified for limitation of flexion and combined ROM as reported on all 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 intervertebral disc syndrome 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 chronic low back pain 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.  

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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-2017-04920.

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.