RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2017-05624
BRANCH OF SERVICE:  Air Force	SEPARATION DATE:  20050829

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Aircraft Armament Systems Journeyman, medically separated for “lumbar spinal stenosis L3-S1 with degenerative disc disease (DDD) L4-S1” with a disability rating of 10%.  

CI CONTENTION:  In addition to “Pain from degenerative disk disease…,” the CI also requested review 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 - 20050713	VARD - 20060130	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Lumbar Spinal Stenosis L3-S1 with DDD L4-S1	5243	10%	Lumbar Spinal Stenosis with DDD	5243	10%	20060104	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Lumbar Spinal Stenosis L3-S1 with DDD L4-S1.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s back condition began in November 2003 after a lifting injury.  Medication, physical therapy (PT) and multiple epidural steroid injections failed to allow return to duty in his specialty.  The neurologist noted surgically correctable pathology, but discouraged surgical options.  MRI in June 2004 revealed L3-S1 stenosis with paracentral disk herniation at L4-5 and L5-S1. 

The 9 June 2005 MEB NARSUM examination, 2 months prior to separation, noted complaints of diffuse low lumbar pain with radiation into the legs.  Physical examination showed no tenderness, positive straight leg raise on the right and mild on the left, with equal strength in the lower bilateral extremities, sensation grossly intact.  There was some paralumbar muscle spasm and gait was antalgic, especially when rising up from a seated position.  There was no range of motion (ROM) recorded.  X-rays in December 2005 showed vertebral heights intact, disc spaces adequate in height and minimal scoliosis.  

At the 4 January 2006 VA Compensation and Pension (C&P) examination, 5 months after separation, the CI reported constant pain rated at 4/10, difficulty with ambulation over half a mile, and flare-ups two times daily, exacerbated by driving, bending or lifting.  He was also awakened at times due to the back pain.  Physical examination showed normal painless ROM, normal gait, and no paravertebral spasm or tenderness.  There was a question of minimal hallucis longus weakness and minimal scoliosis.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, coded 5243 (intervertebral disc syndrome [IVDS]).  The VA also rated the lumbar spinal stenosis with DDD condition 10%, coded 5243, based on the C&P examination, citing minimal right extensor hallucis longus weakness, pain produced on the right of the back and gluteal at 60 degrees, and minimal scoliosis.  

The panel noted that muscle spasm associated with an abnormal gait was present on the MEB NARSUM examination, most proximate to separation.  The panel concluded that this was a sufficient basis for a 20% rating (i.e. for muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour).  There was no documentation of ROM limitation sufficient to rate above 20%.  While the CI may have suffered additional radiating pain, this is subsumed under the general spine rating criteria, which specifically states “with or without symptoms such as pain (whether or not it radiates).”  There was no documentation of IVDS 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 disability rating of 20% for the back condition, coded 5243.  

BOARD FINDINGS:  In the matter of the lumbar spinal stenosis L3-S1 with DDD L4-S1 condition, the panel recommends a disability rating of 20%, coded 5243 IAW VASRD §4.71a.  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 Spinal Stenosis L3-S1 with DDD L4-S1	5243	20%	

SAF/MRB

Dear XXXXXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-05624.

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.