RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2017-05469
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20060510

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Security Apprentice, medically separated for “low back pain (LBP) status post (S/P) L-5 laminectomy and fusion” with a disability rating of 10%.   

CI CONTENTION:  “Not detailed enough.  Did not include…sciatica, nerve pain, decreased bowel function, upper back, and neck pain…hearing loss and ringing in the ears.  Please 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 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 - 20060323	VARD - 20070925	
Condition	Code	Rating	Condition	Code	Rating	Exam	
LBP S/P  L-5 Laminectomy and Fusion	5241	10%	Lumbar Spondylolisthesis [Surgical Residuals]	5239	40%	20060928	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

LBP S/P L-5 Laminectomy and Fusion.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI underwent lumbar surgery on 31 May 2005, 12 months before separation.  Post-operative STR entries documented an uncomplicated recovery with a normal gait and normal neurological findings, and no indication of severe range of motion (ROM) limitation.  There was no STR documentation of incapacitating episodes.  

The 13 February 2006 MEB NARSUM examination, 3 months prior to separation, documented persistent LBP that prohibited running, heavy lifting, and load-bearing.  The physical examination recorded localized tenderness, no note of spasm or gait disturbance, and normal neurological findings.  Measured ROM was flexion to 60 degrees (normal 90) and combined ROM of 180 degrees (normal 240).

The 28 September 2006 VA Compensation and Pension (C&P) examination, 4 months after separation, did not document any interim injury or other exacerbation of the spine condition.  The CI reported persistent symptoms with prolonged sitting, standing, or bending.  She was employed full time and the examiner documented the absence of any incapacitating episodes.  The physical examination recorded lumbar flattening, tenderness, no spasm or guarding, and a normal gait and normal neurological findings (except for some conflicting, thus non-probative, motor findings).   The VA ROM examination was not precise.  Flexion was recorded as “mostly at the hips to about 40 degrees at which time she complains of pain and...is unable to flex further.”  The examiner opined, “It is my estimate that repetitive flexion would result in...loss of 30 degrees flexion and pain would predominate.”    Extension was “approximately” 15 degrees, lateral flexion was 15 degrees right and 20 degrees left, and bilateral rotation was 20 degrees (30 degrees is normal for all of these planes).

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the lumbar spine condition 10%, coded 5241 (spinal fusion), without citing the evidence applied.  The VA rated the condition 40%, coded 5239 (spondylolisthesis), referencing the C&P examiner’s opinion as above and citing the applicable VASRD §4.71a spine criterion of thoracolumbar flexion of 30 degrees or less.

The panel first agreed that the probative value of the C&P ROM evidence was too compromised to serve as reasonable basis for its recommendation.  There was no clinical explanation for such a disparity in ROM limitation between the service and VA evidence, especially considering the absence of spasm or guarding at the time of the C&P examination.  Incorporation of hip flexion is not valid for thoracolumbar ROM assessment, and the examiner’s opinion with regard to estimated flexion after repetition was overly speculative.  The NARSUM ROM examination was most compliant with VASRD §4.46 (accurate measurement) and slightly closer to separation.  The panel thus 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 in the NARSUM examination.  There was no VASRD spine criterion in evidence that would support a higher rating, and 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 recommends a 20% rating for the lumbar spine condition under code 5242 (degenerative arthritis of the spine).

BOARD FINDINGS:  In the matter of the lumbar spine condition, the panel recommends a disability rating of 20%, coded 5242 IAW VASRD §4.71.  There are no other conditions within the panel’s scope of review for consideration.  

The panel recommends the CI’s prior determination be modified as follows, effective the date of medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Lumbar Disc Disease with Surgical Residuals 	5242	20%	

SAF/MRB

Dear XXXXXXXXXXXXX: 

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-05469.

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 not in accordance with the guidelines of the Veterans Affairs Schedule for Rating Disabilities.  Accordingly, the Board recommended modification of your assigned disability rating without re-characterization of your separation with severance pay. 

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding, accept the recommendation and direct that your records be corrected as set forth in the attached copy of a Memorandum for the Chief of Staff, United States Air Force.  This will not result in any change to your separation documents or the amount of severance pay you are entitled to.  Disability severance pay is computed the same regardless of a rating of 0, 10 or 20 percent.