RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXX	CASE:  PD-2013-01227
BRANCH OF SERVICE:  AIR FORCE	BOARD DATE:  20141104
SEPARATION DATE:  20041022

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty A1C/E-2 (2A636/Electro Environmental Specialist) medically separated for chronic back pain.  The condition could not be adequately rehabilitated to meet the physical requirements of his Air Force Specialty or satisfy physical fitness standards.  He was issued a P4 profile and referred for a Medical Evaluation Board (MEB).  The lower back pain condition was forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated “chronic back pain with herniated nucleus pulposus L4-L5” as unfitting, rated at 20%, citing criteria of the Veterans Affairs Schedule for Rating Disabilities (VASRD);  the overweight and tobacco abuse conditions were determined to be Category III.  The CI made no appeals and was medically separated.

CI CONTENTION:  “Amount insufficient to compensate for lost wages.”

SCOPE OF REVIEW: The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e.(2).  It is limited to those conditions determined by the PEB to be unfitting for continued military service and those conditions identified but not determined to be unfitting by the PEB when specifically requested by the CI.  The rating for the unfitting back pain condition is addressed below and no additional conditions are within the DoDI 6040.44 defined purview of the Board.  Any conditions or contention not requested in this application, or otherwise outside the Board’s defined scope of review, remain eligible for future consideration by the Air Force Board for Correction of Military Records.

RATING COMPARISON:  

Service IPEB – Dated 20040827	VA - (7 Mos. Post-Separation	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Back Pain	5237	20%	Residuals Compression Fracture T-Spine w/Traumatic DDD	5237	10%	20050518	
Other x 2 (Not in Scope) 	Other x 2	
Combined:  20%	Combined:  10%	
Derived from VA Rating Decision (VARD) dated 20050706 (most proximate to date of separation)

ANALYSIS SUMMARY:  

Chronic Back Pain Condition.  The CI reported that he suffered a back injury while carrying heavy equipment in January 2003.   The initial diagnosis was a compression fracture of T11, but a magnetic resonance imaging study found no evidence of fracture but did reveal evidence of juvenile spinal kyphosis (Scheuermann’s disease), Schmorl’s nodes and L3-4 and L4-5 disc bulging.  The CI was referral to and seen by neurosurgery, physical therapy and pain management but nonetheless refused the purposed treatment recommendation which included spinal surgery and [steroid] spinal injections.

The narrative summary (NARSUM) dated 29 July 2004 (3 months prior to separation), contained no reports of numbness/tingling, radiating pain or weakness.  The CI’s MEB physical examination reported that the CI had a normal gait; straight leg raise test were negative for radiculopathy; normal deep tendon reflexes; normal vibratory/positional sensations and normal strength.  There was tenderness to palpation over the L1-5 spine.  The consultation for a physical therapy range-of-motion (ROM) was obtained on 13 January 2003 (23 months prior to separation) and it captures the “trunk” ROM which is summarized in chart below.

At the VA Compensation and Pension (C&P) examination performed on 18 May 2005 (7 months post-separation), the CI reported that his current occupation was a security officer and the examiner noted there were no reports/documentation of incapacitating episodes in service treatment records for the past 12 months.  Physical examination revealed lumbar muscle spasms, tenderness on the left paraspinous muscles, positive bilateral straight leg raise test and that the CI “limped” with the right leg.  The VA C&P’s ROM summarized in below chart, additionally documentation that the ROM was limited by 10 degrees due to pain after repetitive use; there were no reports of fatigability and incoordination.

The ROM evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria summarized in the following chart:

Thoracolumbar ROM
(Degrees)	PT ~23 Mo. Pre-Sep
(20030131)	VA C&P ~ 7 Mo. Post-Sep
(20050518)	
Flexion (90 Normal)	30	90 w/pain	
Extension (30)	10	20 w/pain	
R Lat Flexion (30)	25	20 w/pain	
L Lat Flexion (30)	25	20 w/pain	
R Rotation (30)	#	(30) 40 w/pain	
L Rotation (30)	#	 (30) 50 w/pain	
Combined (240)	--	210	
Comment	“Trunk” not thoracolumbar.
Not goniometric ROM.	Limping Gait.
Tender Spasm.
Radiating pain.
Additional limitations after repetitive use by 10 degrees.	
§4.71a Rating	--	10%	

The Board directs attention to its rating recommendation based on the above evidence.  The Board considered VASRD diagnostic code 5237 (lumbosacral or cervical strain) used by the PEB for a 20% rating and the VA for a 10% rating.  IAW DoDI 6040.44 the Board may not recommend a lower combined rating than that conferred by the PEB.  However, the close temporal alignment of the VA C&P evidence with the date of separation, shall remain as the Board’s definitive benchmark in its recommendations.  The VA C&P examination was additionally compliant with VASRD goniometric ROM standards.  The NARSUM cited the physical therapist “trunk” ROM that is usually prepared using the bubble inclinometer instead of a goniometer.  The Board thus assigned more probative value to the VA C&P examination for a rating recommendation at the time of separation in consideration of VASRD §4.46 (accurate measurement).  At the post-separation C&P examination, the CI did not report interim history of further injury, surgery, or other aggravation of the condition by his employment status as a security officer.  The Board did not find evidence in the treatment record for a rating in the CI’s favor.  There were no incapacitating episodes (physician prescribed bed rest) or neurological impairments providing a rating advantage using alternate or additional coding options.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the chronic back pain condition.

BOARD FINDINGS:  The Board did not surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD were exercised.  In the matter of the chronic back pain condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.

RECOMMENDATION:  The Board, therefore, recommends that there be no recharacterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20130910, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

	           
SAF/MRB

Dear XXXXXXXXXXXXXX:

	Reference your application submitted under the provisions of DoDI 6040.44 (Title 10 U.S.C. § 1554a), PDBR Case Number PD-2013-01227

	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.

Attachment:
Record of Proceedings