RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXX 	CASE:  PD-2017-05569
BRANCH OF SERVICE:  Air force	SEPARATION DATE:  20050408

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Special Vehicle  Maintenance Apprentice, medically separated for “chronic low back pain” with a disability rating of 10%.  

CI CONTENTION:  Review requested of additional conditions not identified by the Medical Evaluation Board (MEB) and/or 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 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 - 20050217	VARD - 20050830	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5243	10%	Lumbar Herniated Nucleus Pulposus L5-S1	5237	10%	20050707	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI suffered an atraumatic onset of persistent low back pain in June 2003.  An MRI in September 2003 demonstrated disc disease at L5-S1 with no stenosis or nerve root impingement.  Multiple neurological examinations were normal and surgery was discussed but reasonably deferred.  Provider entries in the STR documented grossly normal or non-specific range of motion (ROM) limitation, as well as normal gait and spinal contour, with no record of incapacitating episodes.  

The 26 October 2004 MEB NARSUM examination, 6 months prior to separation, noted nonspecific low back pain that prohibited running and heavy lifting.  Physical examination recorded a normal spinal contour without note of gait disturbance, tenderness without note of spasm, and normal neurological findings (5/5 motor, intact sensory, symmetric reflexes). Thoracolumbar ROM measurements showed flexion to 90 degrees (normal) and a combined ROM of 230 degrees (normal 240). 

At the 7 July 2005 VA Compensation and Pension (C&P) examination, 3 months after separation, the CI reported constant low back pain, rated at 9/10, with “limited ability to bend, lift, and sit.”  The examiner documented the absence of any incapacitating episodes and noted a normal gait, no tenderness or spasm, and normal neurological findings.  Flexion was to 80 degrees and combined ROM was 235 degrees, with painful motion but no ROM degradation after repetition.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the lumbar spine condition 10%, coded 5243 (intervertebral disc syndrome), citing localized tenderness.  The VA also rated the condition 10%, but coded 5237 (lumbosacral strain), based on the C&P examination, citing the applicable VASRD §4.71a spine criteria for flexion and combined ROM.  Panel 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) and/or combined ROM (greater than 120 degrees but not greater than 235 degrees), as reported in the NARSUM and VA C&P examinations.  There was no evidence of an abnormal gait or spinal contour, thus the next higher 20% rating was not justified on this basis.  Additionally, 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 spine condition.  

BOARD FINDINGS:  In the matter of the lumbar spine 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 CI’s disability and separation determination.  

SAF/MRB

Dear XXXXXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-05569.

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.

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that modification of your disability rating or characterization of your separation is not warranted.  Accordingly, I accept the recommendation that your application be denied.