RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-05114
BRANCH OF SERVICE:  air force 	SEPARATION DATE:  20050601

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a Reserve O5, C-130 Mobility Navigator, medically separated for “chronic low back pain” with a disability rating of 10%.   

CI CONTENTION:  “Unable to sleep because of pain.  Walking is difficult.  Muscle has detached from bone.”  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 - 20050330	VARD - 20060824	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5242	10%	Degenerative Disc Disease, Lumbar Spine	5243	10%	20060603	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  80%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s back pain began in September 2003 after he started a running program.  Radiographic studies showed partial L5 vertebral body sacralization with significantly decreased disc height at L5-S1 and degenerative changes.  Lumbar imaging showed a disc bulge at L4-L5.  

The 10 December 2004 MEB NARSUM examination, 6 months prior to separation, noted complaints of low back pain and numbness over the anterior right thigh.  The examiner observed that the CI appeared to be in moderate pain and was not able to sit for long periods of time.  The extremities had full range of motion (ROM) without deformity, but the examination did not include thoracolumbar ROM measurements or address painful motion.  

At the 15 April 2006 VA Compensation and Pension (C&P) general examination, 10 months after separation, the CI reported a constant ache in the lower back with dull pain and numbness radiating down both sides to the feet.  He reported no injury but lots of heavy training and physical labor.  Physical examination showed “pain at 80 forward flexion and 25 extension.”  

At the 3 June 2006 VA C&P spine and peripheral nerve examinations, 12 months after separation, the CI complained of daily back pain which radiated into the lower extremities.  Physical examination showed a normal gait, mild lumbar tenderness, and moderate muscle spasm.  Flexion was to 70 degrees (normal 90) and combined ROM was 210 degrees (normal 240).  There was no evidence of increased pain, fatigability, lack of endurance or in coordination with repeated motion.  There were no reflex or motor defects involving the lower extremities, but there was decreased sensation to light touch in the posterior leg extending from the ankle all the way up to the buttocks.  X-rays revealed mild degenerative changes.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, coded 5242 (degenerative arthritis of the spine).  The VA also rated the back condition 10%, but coded 5243 (intervertebral disc syndrome), based on the C&P examination, citing limitation of motion.  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 on the VA examinations.  Although there was muscle spasm, it was not 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 back condition.  

BOARD FINDINGS:  In the matter of the chronic low back pain and IAW VASRD §4.127a, 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.  

Dear XXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-05114.

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.