RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXX	CASE:  PD-2013-01580
BRANCH OF SERVICE:  AIR FORCE	BOARD DATE:  20140812
SEPARATION DATE:  20041206

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SrA/E-4 (1C051/Airfield Management) medically separated for low back pain (LBP).  The back condition could not be adequately rehabilitated to meet the physical requirements of her Air Force Specialty or satisfy physical fitness standards.  She was issued an L4 profile and referred for a Medical Evaluation Board (MEB).  The condition, characterized as “chronic low back pain” was forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123.  No other conditions were submitted by the MEB.  The PEB adjudicated “chronic low back pain with L5-S1 posterior fusion defect and degenerative changes” as unfitting, rated 10% IAW the Department of Defense and VA Schedule for Rating Disabilities (VASRD) guidelines.  An “overweight” condition was listed as Category III (not separately unfitting, and not contributing to the unfitting condition).  The CI made no appeals and was medically separated.

CI CONTENTION:  “My back pain has affected and does affect my daily life negatively.  I have lost several jobs because I cannot perform to the standards required due to my severe back pain.  I cannot do activities with my children.  I cannot clean my house.  My husband does all the cleaning and helps the children with everything they need because I am unable to because of my back pain or I am too depressed to participate.  There are mornings when I wake up and my husband has to bring me pain medicine to take before I can even get out of bed because my back will be aching and hurting so bad.  My back pain and depression have ruined my life.”

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 LBP condition is addressed below.  No other conditions are within the defined purview of the Board.  Any conditions outside the Board’s scope of review may be eligible for consideration by the Board for Correction of Military Records.

RATING COMPARISON:

Service IPEB – Dated 20040805	VA – (34 months Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5237	10%	Bone Defect in Neural Arch at L5 w/occasional Sciatica	5243	10%	20070914	
Other x 0 (Not in Scope)	Other x 4	20070321	
Combined:  10%	Combined:  20%	
Derived from VA Rating Decision (VARD) dated 20071009 (most proximate to date of separation [DOS])

ANALYSIS SUMMARY:  The Board acknowledges the sentiment expressed by the CI regarding the impairment with which her back condition continues to burden her, and the significant impact it has had on her quality of life.  It is noted for the record that the Board is subject to the same laws for disability entitlements as those under which the Disability Evaluation System (DES) operates.  The DES has neither the role nor the authority to compensate members for future severity or potential complications of conditions.  That role and authority is granted to the Department of Veterans Affairs (DVA).  The Board evaluates DVA evidence in arriving at its recommendations, but its authority resides in evaluating the fairness of DES fitness and rating determinations at the time of separation.  In addition, while other symptoms and conditions may have been present, DES compensation can only be offered for those conditions that cut short a member’s career and then only to the degree of severity present at the time of separation.  The DVA, however, is empowered to compensate for all service-connected conditions and to periodically re-evaluate conditions for the purpose of adjusting the Veteran’s disability rating should the degree of impairment change over time.

Low Back Pain (LBP).  The CI started having LBP about a year after entering the Air Force.  She was treated with multiple medications.  However, her pain persisted and an MEB was initiated. The MEB narrative summary was dictated on 30 April 2004.  Physical exam (PE) of her back showed a negative straight leg raise bilaterally.  Neurological exam of the lower extremities was normal.  Range-of-motion (ROM) was measured and is summarized in the chart below.  The CI was separated on 6 December 2004.  Thirty-four months later, she had a VA Compensation and Pension exam.  At that exam, posture and gait were normal.  The spine was symmetric and had no abnormal curvature.  PE of the back revealed no atrophy, guarding, weakness, tenderness, spasm, or pain with motion.  Neurological exam of the lower extremities was normal.  The ROM evaluations which the Board weighed in arriving at its rating recommendation, are summarized in the chart below.

Thoracolumbar ROM
(Degrees)	FP ~ 7 mos. Pre-Sep
(20040430)	MEB ~ 6 mos. Pre-Sep
(20040430)	VA C&P ~ 34 mos. Post-Sep
(20070914)	
Flexion (90 Normal)	75	70	90	
Extension (30)	(Painful) 	None (due to pain)	10	
R Lat Flexion (30)	Normal	Full	30	
L Lat Flexion (30)	Normal	Full	30	
R Rotation (30)	Normal	Full	30	
L Rotation (30)	Normal	Full	30	
Combined (240)	n/a	190	220	
§4.71a Rating	10%	10%	10%	

The Air Force PEB and the VA chose different coding options for the back condition, but both assigned a disability rating of 10%.  The Board carefully examined all available evidence, and directs attention to its rating recommendation.  The Board considered the back examinations described above.  The April 2004 MEB exam was performed closer to the time of separation.  At that exam, thoracolumbar forward flexion was 70 degrees and thoracolumbar combined ROM was 190 degrees.  IAW VASRD §4.71a, a 10% rating is warranted when forward flexion is greater than 60 degrees but not greater than 85 degrees.  A 10% rating is also warranted when combined thoracolumbar ROM is greater than 120 degrees but not greater than 235 degrees.  After a thorough review of the evidence, the Board determined that a disability rating of 10% was appropriate.  The Board attempted to find a path to a higher rating, using other codes which could be applied to the LBP condition.  The other VASRD codes that were considered did not result in a higher rating, since the treatment record did not show sufficient evidence of a disabling spine condition which would justify a rating higher than 10%.

The Board also considered the matter of peripheral neuropathy.  After reviewing all the information in the record, there was insufficient evidence of a clinically significant neuropathy that interfered with performance of military duties.  The CI also had neurological symptoms.  However, there was no performance-based evidence that the neurological condition impacted her military duties.  Therefore, the Board concluded that there was no unfitting radiculopathy present at the time of separation.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board found insufficient cause to recommend a change in the PEB adjudication for the LBP condition.

Other Contended Conditions.  The CI contended that she suffered from depression.  As noted above, depression was not within the Board’s scope of review.

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 LBP 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 recharacterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20130925, 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-2013-01580.

	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