RECORD OF PROCEEDINGS 
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXX 		BRANCH OF SERVICE: AIR FORCE  
CASE NUMBER:  PD0900439		BOARD DATE: 20100601
SEPARATION DATE: 20020128 
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SUMMARY OF CASE:  This covered individual (CI) was SRA/E-4, (Aircraft Armament, 2W151) medically separated from the Air Force in 2002 after 2 years and 10 months of service.  The medical basis for the separation was Chronic Low Back Pain.  The Low Back Pain and Migraine Headaches were determined to be medically unacceptable.  The CI was referred to the Physical Evaluation Board (PEB), determined unfit for the Low Back Pain condition, and separated at 10% disability using the Veterans Affairs Schedule for Ratings Disabilities (VASRD) and applicable Air Force and Department of Defense regulations.
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CI CONTENTION:  The CI states: “I still have daily pain associated with my back, and now my neck as a result of my herniated disc. I have received ongoing medical and chiropractic care as I could afford it, with little relief.”
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RATING COMPARISON:

Service PEB  	VA (7 Years  Separation)	
Condition	Code	Rating	Date	Condition	Code	Rating	Exam	Effective	
Chronic Low Back Pain	5293	10%	20011127	Herniated Disc L5-S1	5295	10%	Treatment Records from Holland Chiropractic 12/2002 – 1/2003

C&P Exam 20091105	20020129	
									
Migraine Headaches	Cat II	Not Unfitting		Migraine Headaches	8100	NSC			
TOTAL Combined:  10%	TOTAL Combined:    
10%  from 20020129 	
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ANALYSIS SUMMARY:

Back Pain/Herniated Disc:
The CI fell going down the steps of her dormitory residence in May 2000 and had unresolved back pain ever since.  Treatment modalities included non-steroidal anti-inflammatory medication, physical therapy, duty restrictions, and two epidural steroid injections, but none of these led to resolution of her back pain.  A Magnetic Resonance Imaging (MRI) in June 2001 did show a mild to moderate focal central disc protrusion at L5-S1 with mild mass effect upon the thecal sac.  No foraminal narrowing was seen.  An orthopedic consult revealed that she was not a surgical candidate.

As a result of this condition the CI was on light duty with exercise as tolerated, no push-ups, and no heavy lifting over 30 pounds.  She had limited range of motion of thoracolumbar flexion and side-to-side twisting secondary to pain and was unable to perform her required duties.  No neurologic abnormalities were noted in the service treatment record (STR) and she had a negative straight leg raise documented in the narrative summary (NARSUM) of 20011018.

Movement
Thoracolumbar	Normal ROM	NARSUM
20011018	Holland Chiropractic
20021206	ROM VA
20091105	
Flex	0-90	Limited by pain	80	90	
Ext	0-30		?	3 (typo?)	
R Lat flex	0-30		40 (30 for rating)	30	
L lat flex	0-30		40 (30 for rating)	30	
R rotation	0-30	Limited by pain	30	30	
L rotation	0-30	Limited by pain	30	30	
COMBINED	 240		200-230	210-240	
Notes:		Gait is slightly antalgic; Reflexes 2+ bilaterally; negative straight leg raise; MRI 20010618 focal disc protrusion at L5-S1		X-ray: L5-S1 disc space narrowing; wearing high heeled boots	

MRI OF THE LUMBAR SPINE 20010618 -- TECHNIQUE:  MRI evaluation of the lumbar spine was accomplished with spin echo T1 weighted and fast spin echo T2 weighted pulse sequences with the GE Signa 1.0 Tesla MRI System.  Imaging was performed in the sagittal and axial planes.

FINDINGS: The lumbar vertebral bodies are of normal alignment and signal intensity.  There is evidence of mild disc space narrowing at L5-S1 with evidence of disc desiccation.  Remaining intervertebral discs are of normal signal and height.  There appears to have been attempted lumbarization of S1, as noted on the plain films.

At L5-S1, there is evidence of a mild to moderate focal central disc protrusion with mild mass effect upon the thecal sac. No foraminal narrowing is seen.  No facet arthrosis is identified. Follow-up per Orthopedics.

IMPRESSION: MRI EVALUATION OF THE LUMBAR SPINE REVEALS A FOCAL CENTRAL DISC PROTRUSION AT L5-S1.

Migraine Headaches:  No evidence this was unfitting at the time of separation from service.  No duty restrictions attributable to this condition.
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BOARD FINDINGS:  IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB will not be considered by the Board to the extent they were inconsistent with the VASRD in effect at the time of the adjudication.  After careful consideration of all available information the Board unanimously determined that the CI’s condition is most appropriately rated at 10%.

Without muscle spasm, loss of lateral spine motion, or recurring attacks of neurologic findings consistent with spinal nerve root compression, the CI’s pain-limited spinal range of motion at the time of separation from service in 2002 warrants a 10% rating under either VASRD 5293 or 5295.

The Board also considered the condition of Migraine Headaches and unanimously determined that this condition was not unfitting at the time of separation from service.  No duty restrictions or limitations are attributable to this condition.  This condition did not contribute to the CI’s ability to perform duties required of her rank and specialty.
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RECOMMENDATION:  The Board therefore recommends that there be no recharacterization of the CI’s disability and separation determination.
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The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20090710, w/atchs.
Exhibit B.  Service Treatment Record.
Exhibit C.  Department of Veterans' Affairs Treatment Record.

                         

SAF/MRB
1535 Command Drive, Suite E-302
Andrews AFB, MD  20762-7002

	Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2009-004439

	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 with severance pay.

	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.