RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2018-00215
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20020524

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Aerospace Ground Equipment Journeyman, medically separated for “chronic low back pain” and “right shoulder impingement associated with scar revision,” rated 10% and 0%, respectively, with a combined disability rating of 10%. 

CI CONTENTION:  In addition to his back, review of additional conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB) was requested.  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 - 20020125	VARD - 20030123	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5295	10%	Broad-Based Degenerative Disc Disease (DDD) Lumbosacral Spine	5293-5292	20%	20021105	
Right Shoulder Impingement, Associated with Scar Revision	5305	0%	Impingement Syndrome, Right Shoulder(Major)	5201	0%		
			Status Post Basal Cell Carcinoma, Right Shoulder, Excised with Large Z-Plasty Scar	7818-7804	10%		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s back condition began in December 1994 after running up stairs that continued to worsen over time.  Despite medication, physical therapy (PT) and prolotherapy (regenerative injection therapy), the CI was unable to continue serving in his specialty.  Radiographic studies (MRI) on 19 November 2002 showed mild broad-based disc bulge of the mid and lower lumbar spine.  The 8 January 2002 MEB NARSUM examination, 4 months prior to separation, noted complaints of low back pain that ranged in intensity from 4/10-9/10, on a scale 0-10.  Physical examination showed the spine was straight and symmetric with tenderness.  Range of motion (ROM) was “decreased” and painful motion was present.  Muscle spasm was not recorded. 

At the 5 November 2002 VA Compensation and Pension (C&P) examination, 6 months after separation, the CI reported back pain.  Physical examination revealed a distinct limp to the right during ambulation, and forward flexion of the spine to 60 degrees, and combined ROM of 150 degrees.

The panel directed attention to its rating recommendation based on the above evidence.  The 2002 VASRD coding and rating standards for the spine, which must be applied to the panel’s recommendation IAW DoDI 6040.44, differ significantly from the current §4.71a general rating formula for the spine.  The 2002 Veterans’ Administration Schedule for Rating Disabilities (VASRD) was in effect at the time of separation (DOS). The PEB rated the back condition 10%, coded 5295 (lumbosacral strain:).  The VA rated the back condition 20%, dual coded 5293-5292 (spine, limitation of motion of, lumbar – Intervertebral disc syndrome), based on the C&P examination, citing moderate limitation of motion of the lumbar spine.  

There was no numerical ROM measurement recorded in the NARSUM or any STR encounter prior to separation, just the NARSUM’s notation of “decreased” ROM.  The panel noted the VARD indicated normal lumbar ROM 95 degrees, which actually is considered normal thoracolumbar ROM.   Normal isolated lumbar flexion is widely considered to be approximately 60 degrees.  Therefore, the flexion ROM recorded at the C&P examination represents normal lumbar flexion ROM.  Panel members agreed, the 10% rating and no higher was warranted for limitation of lumbar motion, based on the NARSUM finding of decreased ROM.  There was no documented incapacitating episodes of at least one week duration related to the back.  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 back condition.  

Right Shoulder Impingement, Associated with Scar Revision.  According to the STR and MEB NARSUM, the CI’s right shoulder condition began in October 1999 after surgery for basal cell cancer removal and subsequent wound breakdown and scar revision by surgery in 2000.  Radiographic studies (X-ray) on 5 November 2002 was negative.  MRI on 19 November 2002 showed mild effacement of the subacromial-subdeltoid fat and a small lateral acromial spur causing mild impingement upon the rotator cuffs, particularly the supraspinatus, but no evidence of a rotator cuff tear.  At the physical therapy examination the CI reported difficulty lifting weights, pain with lifting overhead and pain with dressing.  Forward flexion of right shoulder was 100 degrees and abduction to 100 degrees (both normally 180).  Pain was present throughout ROM testing, and there was tenderness and decreased sensation about the surgical scar.  The MEB NARSUM examination noted complaints of right shoulder pain. Physical examination showed skin with surgical scar associated with numbness, and decreased right shoulder ROM.

At the C&P examination the CI reported numbness and burning at the site of the scar, and pain in his shoulder, with pops and grinds.  Physical examination showed a scar of about 14cm in size that was normally pigmented but tender.  Right shoulder had 100 degrees of flexion, and 110 degrees of abduction.  Strength, and dexterity of the fingers were normal.  The 19 November 2002 MRI of the right shoulder showed mild hypertrophic degenerative changes of the AC joint.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right shoulder and scar condition 0%, coded 5305 (Group V. Function:).  The VA rated the right shoulder impingement condition 0%, coded 5201 (arm, limitation of motion of), based on the C&P examination, citing a noncompensable evaluation.  The VA also rated the s/p basal cell carcinoma, right shoulder, excised with large z-plasty scar condition 10%, dual coded 7818-7804 (malignant skin neoplasms (other than malignant melanoma) - scar(s), unstable or painful:), based on the C&P examination, citing a superficial scar that is painful on examination.  

Panel members agreed, a compensable rating under code 5305 is not supported since evidence of moderate impairment of elbow supination or pronation was not present. Likewise, there was no evidence to support a rating under muscle group codes 5301, 5302, 5303 or 5304.  There was insufficient limitation of motion to support a rating under the 5201 code. However, panel members agreed that a 10% rating was justified with application of VASRD §4.59 (painful motion).  There was no malunion or recurrent dislocation of the humerus to justify a rating under the 5202 code (humerus, other impairment of); and no nonunion with loose movement of the clavicle to warrant a rating under the 5203 code (clavicle or scapula, impairment of).  Additionally, there was no evidence that the surgical scar imposed a direct functional impairment that would have rendered the CI unfit.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the right shoulder condition, coded 5201.  

BOARD FINDINGS:  In the matter of the chronic low back pain condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the right shoulder impingement, associated with scar revision condition, the panel recommends a disability rating of 10%, coded 5201 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	
Chronic Low Back Pain	5292	10%	
Right Shoulder Impingement, Associated with Scar Revision	5201	10%	
COMBINED	20%	

SAF/MRB
3351 Celmers Lane
JBA NAF Washington, MD 20762-6435

Dear XXXXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2018-00215.

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.