SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD 20762

Dear XXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-05617.

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.

RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-05617
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20080402

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Pavements and Construction Equipment Craftsman, medically separated for “chronic low back pain” with a disability rating of 20%.  

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 - 20080220	VARD - 20090314	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5243	20%	Residuals of Decompressive Surgery L4-5 	5243	10%	20080822	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain (LBP).  According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent back surgery with decompression and discectomy in January 2007, and had an acute onset of back pain in June 2007.  An MRI on 19 June 2007 showed moderate L4-5 epidural scar formation and bulging annulus, but no evidence of a recurrent disc herniation.  At a 7 August 2007 orthopedic visit, 7 months after surgery, the CI reported persistent LBP with recent recurrence of left leg pain.  Physical examination showed normal gait and spine alignment, no tenderness, and normal flexion (not quantified) with painful motion.  

The 16 November 2007 MEB thoracolumbar range of motion (ROM) evaluation, 5 months before separation, showed, in degrees: flexion of 80 (normal 90), extension of 20 (normal 30), left and right lateral flexion of 25 each (normal 30), “normal” right rotation (normal 30), and left spine rotation at 75% (presumably 25 degrees), for a combined ROM of 205 (normal 240).  Painful motion, tenderness, spasm, guarding, gait or spinal contour were not mentioned.  On 3 December 2007, physical therapy ROM measurements, in degrees and using an inclinometer, showed:  lumbar flexion of 45 (normal 60), extension of 10 (normal 25), left lateral flexion of 20 (normal 25), and right lateral flexion of 15 (normal 25).  The 11 December 2007 MEB NARSUM examination, 4 months prior to separation, noted complaints of LBP that prevented running or carrying more than 25 pounds.  Physical examination showed a normal gait and tenderness over the entire lumbar spine.  The examiner reported that the CI was unable to perform full ROM due to pain.  

At a VA physical therapy consult on 2 June 2008, 2 months after separation, the examiner noted tenderness, muscle tightness, and a flattened lumbar curve, but no guarding.  Measured ROM, in degrees, showed:  flexion to 55, extension to 15, left lateral flexion to 20 and right lateral flexion to 25, with painful motion.  Rotation measurements were not provided.  During the 22 August 2008 VA Compensation and Pension (C&P) examination, 5 months after separation, the CI complained of LBP, rated at 6-8/10, and aggravated by extended sitting, standing or driving.  He denied incapacitating episodes in the previous 12 months.  Physical examination showed a normal gait and posture, and although there was lumbar paraspinal tenderness, the CI was able to get on and off the examining table without difficulty.  The ROM evaluation showed flexion of 75 degrees, after repetition, with painful motion, and combined ROM of 185 degrees.  There was no mention of spasm or guarding.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 20%, coded 5243 (intervertebral disc syndrome).  The VA rated the back condition 10%, also coded 5243, based on the C&P examination, citing limitation of motion.  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 3 December 2007 MEB and the VA physical therapy examinations.  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 f 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 §4.71a, 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.