RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-05814
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20090626

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

CI CONTENTION:  Review requested of back pain as well as additional conditions not identified by the Medical Evaluation Board (MEB) and 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’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 - 20090402	VARD - 20100825	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Lumbago	5237	10%	Lumbar Spine Degenerative Disk Disease, Degenerative Joint Disease…	5242	10%	20100713	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Low Back Pain.  According to the MEB narrative summary (NARSUM), the CI’s back condition began in November 2006 after slipping and falling from a standing height during technical training.  Despite physical therapy and narcotic pain medications, her pain continued.  The 28 October 2008 MEB NARSUM examination, 8 months prior to separation, noted complaints of chronic low back pain, rated at 4/10.  Physical examination showed a normal gait and posture.  There was tenderness but no spasm, and lumbosacral spine range of motion (ROM) was full with pain.  Motor and sensory findings were normal.  

The 30 December 2008 physical therapy examination, 6 months prior to separation, noted CI complaints of difficulty with running, lying supine and exercising.  Repetitive activity such as lifting or bending exacerbated the back pain.  Physical examination showed normal ambulation and gross coordination.  Spinal ROM was measured with an inclinometer and showed flexion to 90 degrees (normal), extension to 25 degrees (normal 30), and lateral flexion to 30 degrees (normal) on both sides).  Lateral rotation measurements were not reported.  

At the 13 July 2010 VA Compensation and Pension (C&P) examination, 13 months after separation, the CI reported low back pain.  Physical examination showed a normal gait and stance, and tenderness but no spasm.  The examiner noted that she changed positions readily, getting in and out of chairs and on and off the examination table without difficulty.  Strength and reflexes were normal and straight leg raising was negative.  Measured ROM revealed flexion of 90 degrees, and a combined ROM of 220 degrees (normal 240), after repetition.  There was no objective evidence of pain, wincing or grimacing during ROM tests, but she performed the maneuvers somewhat slowly.  There was no evidence of additional pain, weakness, incoordination, or fatigability.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, coded 5237 (Lumbosacral strain) citing Department of Defense guidance for applying the VASRD guidelines.  The VA also rated the back condition 10%, coded 5242 (degenerative arthritis of the spine), based on the C&P examination, citing combined ROM of 220 degrees.  Panel members agreed that a 10% rating, but no higher, was justified for painful motion and tenderness as reported on the NARSUM examination.  There was no muscle spasm or guarding severe enough to result in an abnormal gait or spinal contour, thus the next higher 20% rating was not justified on this basis.  After due deliberation, considering all of 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 CI’s disability and separation determination.  

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-2017-05814.

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.