RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2013-01398
BRANCH OF SERVICE:  AIR FORCE	BOARD DATE:  20150317
SEPARATION DATE:  20041116

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-2 (Aircraft Armament Systems Apprentice) medically separated for low back pain.  The low back condition could not be adequately rehabilitated to meet the physical requirements of his Air Force Specialty.  He was issued a temporary P4 profile and referred for a Medical Evaluation Board (MEB).  The “grade I spondylolisthesis with bilateral pars defect,” was forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123.  No other condition was submitted by the MEB.  The Informal PEB adjudicated “chronic lower back pain associated with grade I spondylolisthesis” as a Category I unfitting condition, rated 10%, citing application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI requested a Formal PEB, but later rescinded that request and was medically separated.

CI CONTENTION:  “Condition has worsened over last 10 years with repetitive work.”

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 when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting.  Any conditions outside the Board’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/Naval Records.  Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the VASRD standards to the unfitting medical condition at the time of separation.  The Board 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 Board 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:

IPEB – Dated 20040421	VA* - (~5 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Lower Back Pain Associated with Grade I Spondylolisthesis	5239	10%	Grade 1 Spondylolisthesis (also Claimed as L5-S2 with Bilateral Par Defect)	Unknown	10%	20050425	
			Thoracic Sprain	Unknown	NSC	20050425	
Other x 0 (Not In Scope)	Other x 0	
RATING:  10%	RATING:  10%	
*Derived from VA Rating Decision (VARD) dated 20050511 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Low Back Pain with Grade I Spondylolisthesis.  The record and narrative summary (NARSUM) indicated that the CI had constant low and mid back pain with increase on activity and with pain radiating up his back.  There was no leg pain reported.  Radiographs documented Grade I spondylolisthesis at L5 on S1 with a bilateral pars defect.  Physical therapy, multiple trials of medications, nerve blocks and radiofrequency ablation did not relieve the symptoms or allow return to full duty due to lifting restrictions.  On orthopedic examination 10 months prior to separation (referenced and summarized in the NARSUM) the CI had a normal gait, had negative straight leg raise testing (for radicular signs), was able to stand on his heels and to squat.  He had pain-limited range-of-motion (ROM) with forward flexion to fingertips touching the ankles, extension to 10 degrees (normal 30) and other axis of movement all having a “10% loss.”  Reflexes and lower extremity sensory and strength exams were normal.  A treatment note from 4 months prior to separation documented moderate muscle spasm with 70% of normal forward flexion and a normal gait.  In his letter of exception to the PEB, the CI noted back spasms and pain radiating into his neck area.

At the VA Compensation and Pension exam performed 5 months after separation, the CI reported increasing pain with sitting and that the low back pain had become intermittent.  He was taking no medications, but had a lifting restriction.  He denied prescribed bed rest for his back condition.  On exam, gait was normal and ROM was with pain to at least the VASRD normal limits for each axis of movement (forward flexion 90 degrees/combined 240 degrees), with no decrease following repetition.  Spine contour was normal and there was normal sensory, reflex and strength testing.

The Board directed attention to its rating recommendation based on the above evidence.  No service exams used a goniometer IAW VASRD §4.46 (accurate measurement).  The NARSUM “fingertips to ankle” was adjudged as near normal ROM (greater than 60 degrees) as was the single exam documenting muscle spasm with “70% normal” forward flexion.  The comprehensive VA exam was the most comprehensive and included assessment following repetition of motion.  All exams in evidence warranted a 10% rating for painful or pain limited motion using the general rating formula for the spine for forward flexion of the thoracolumbar spine greater than 60 degrees or combined ROM of greater than 120 degrees but not greater than 235 degrees.  There was evidence of occasional muscle spasm or tenderness that did not result in abnormal gait or abnormal spinal contour which is also in the 10% criteria range.  Pain, whether or not it radiates, is considered under the general spine formula, and there was no evidence of any lower extremity motor or sensory loss (non-pain radiculopathy) for any potential peripheral nerve rating.  There was no evidence of intervertebral disc disease or physician prescribed bed rest to warrant a higher rating.  Considering the totality of the evidence and mindful of VASRD §4.3 (reasonable doubt), members agreed that a disability rating of 10% for the low back condition was appropriately recommended in this case.

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.  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 low back condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration.

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

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20130912, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

	

Dear XXXXXXXXXXXXXXXXXXXX:
	
Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2013-01398.

	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

cc:
SAF/MRBR