Dear XXXXXXXXX:

1554,

Reference your application submitted under the provisions of DoDI 6040.44 (Section 10 USC), PDBR Case Number PD-2017-05333.
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.
concur I have carefully reviewed the evidence of record and the recommendation of the Board. I concur with that finding and their conclusion that medication of your disability rating or characterization of your separation is not warranted. Accordingly, I accept the recommendation that your application be denied.

PD-2017-05333

RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME: XXXXXXXXXXXXXXXXXXX

CASE: PD-2017-05333

BRANCH OF SERVIC E: AIR FORCE	SEPARATION DATE: 20081212

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (Cl) was an active duty ES, Security Forces Craftsman, medically separated for "low back pain" with a disability rating of 20%.

Cl CONTENTION: Condition continues to worsen. 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 Cl, 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 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 • 200	1024	VARD • 20090505	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Low Back Pain Status Post Spinal Fusion	5241	Lumbar Spine Degenerative Disc
20%	Disease  and Degenerative Joint Disease, Treated with Spinal Fusion	5299-5241	10%	20090218	
COMBINED RATING: 20%	COMBINED RATING OF ALL VA CONDITIONS: 30%	

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ANALYSIS SUMMARY:
Low Back Pain (LBP). According to the service treatment record and MEB narrative summary (NARSUM), the Cl had back surgery with decompression and an instrumented fusion at L2-LS on 10 March 2008. Postoperatively, he underwent bone stimulation and physical therapy, however, the pain persisted. The 20 August 2008 MEB NARSUM examination, 4 months prior to separation, noted the Cl was not able to run based on recommendations from his orthopedic surgeon, but he did exercises and low impact activities. Physical examination showed tenderness with lumbar range of motion (ROM) "limited to due fusion, but no pain with flexion or extension of back." At the 9 September 2009 physical medicine examination, 3 months before separation, ROM measurements showed flexion of 40 degrees (normal 90) and a combined ROM of 160 degrees (normal 240), with painful motion but no mention of spasm. Lumbar spine X-rays on 7 November 2008 showed a diminishing posterolateral fusion mass, but no evidence of migration or hardware failure. At a family practice visit on 7 November 2008, the Cl walked about the room with a normal gait and station and could heel and toe walk effectively. At the 18 February 2009 VA Compensation  and Pension  (C&P) examination,  2 months after  separation,  the  Cl   reported 
PD-2017-05333

constant midline pain in the lumbar spine region and limitation of motion with repetition. Physical examination showed a normal gait, and measured ROM revealed flexion of 90 degrees, with painful motion, and a combined ROM of 230 degrees.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the low back condition 20%, analogously coded 5299-5241 (spinal fusion). The VA rated the low back condition 10%, analogously coded 5299-5241, based on the C&P examination, citing combined thoracolumbar ROM greater than 120 degrees but not greater than 235 degrees. Panel members 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 physical medicine examination. 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 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 Cl's disability and separation determination.

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