RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2018-00030
BRANCH OF SERVICE:  Air force	SEPARATION DATE:  20080804

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Medical Material Journeyman, medically separated for “low back pain with degenerative disc disease [DDD] and disc protrusions” with a disability rating of 20%.  

CI CONTENTION:  “At the point of discharge they just had back pain.  The VA actually gave it a name Ankylosing Spondylitis.”  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 PEB, but determined 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.  Furthermore, the panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to 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, operating 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 the disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20080623	VARD - 20080911	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Low Back Pain… 	5243	20%	Sacroiliac Back Strain Associated With DDD And Sacrum Fracture	5003-5236	10%	20080813	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Low Back Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s low back condition began in October 2006 after undergoing a colonoscopy.  Initial lumbar X-rays on 20 October 2006, as well as lumbar spine and pelvic CT imaging on 14 February 2007, were negative, but MRI studies on 15 March 2007 revealed mild disc bulges at L3-L4 and L4-L5.  During a 9 August 2007 physical therapy (PT) appointment, 12 months prior to separation, the CI related lower back and coccyx pain not relieved by two prior epidural steroid injections or pain management clinic intervention.  The pain was sharp and increased with sitting, bending, and quick movements.  Physical examination showed a normal appearing thoracolumbar spine with tenderness of the sacro-coccygeal joint, but no muscle spasms.   The examiner noted  the thoracolumbar spine “did not demonstrate full ROM [range of motion] and is decreased in flexion at 36 degrees (limited by pain).”  

At the family practice (FP) appointment on 5 September 2007, the provider noted unchanged complaints, and the examination showed less than full thoracolumbar ROM with pain at the extremes of motion (no measurements provided), and tenderness at the sacrum and sciatic notches.  The 4 January 2008 FP follow-up evaluation, 7 months prior to separation, noted continued back pain, and the examiner documented “restricted in forward bending to approx. 45 degrees before pain, rotation and side bending unrestricted.”

The 7 May 2008 MEB NARSUM examination, 3 months before separation, noted CI reports of chronic low back pain after failed conservative therapy; evaluations by neurology and neurosurgery (most recent on 17 April 2008) indicated he was not a surgical candidate.  Physical examination showed a normal gait, back strength and stability, but painful forward spine flexion with radiation to the tailbone area.  Formal thoracolumbar ROM performed by PT on 20 May 2008, recorded active flexion to 40 degrees (normal 90), with a combined ROM of 160 degrees (normal 240), after repetition.  During the FP visit on 10 July 2008, the examiner noted bilateral lumbosacral tenderness and ROM measurements within normal limits.  

At the 13 August 2008 VA Compensation and Pension (C&P) examination, 10 days after separation, the CI reported low back pain.  Physical examination showed no abnormal spinal curvatures, spasms, atrophy, guarding, tenderness, or weakness.  Posture and gait were normal as were strength and reflexes.  Thoracolumbar ROM measurements documented active flexion to 90 degrees, with pain beginning at 70 degrees, and a combined ROM of 240 degrees.  There was pain but no additional loss of motion with repetitive use.  The diagnosis was sacroiliac back strain associated with DDD and sacrum fracture.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back condition 20%, coded 5243 (intervertebral disc syndrome (IVDS)).  The VA rated the low back condition 10%, coded 5003-5236 (sacroiliac injury and weakness), based on the C&P examination, citing pain on motion and X-ray evidence of degenerative joint disease.  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 MEB PT examination.  Also, there was no evidence of IVDS which resulted in incapacitating episodes requiring physician-prescribed bed rest to warrant consideration of rating under the alternate VASRD formula for that condition.  The panel noted that the VA General Rating Formula for Diseases and Injuries of the Spine is used for codes 5235 to 5242, including code 5240 ( ankylosing spondylitis), and that any alternative coding would not provide a rating higher than that adjudicated by the PEB.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that 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
3351 Celmers Lane
JBA NAF Washington, MD 20762-6435

Dear XXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2018-00030.

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.