RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXX	CASE:  PD-2013-01921
BRANCH OF SERVICE:  AIR FORCE	BOARD DATE:  20140620
SEPARATION DATE:  20040809

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SSgt/E-5 (2W1/Aircraft Armament Systems) medically separated for chronic back pain.  The condition did not improve adequately to meet the physical requirements of his Air Force Specialty or satisfy physical fitness standards.  He was issued a permanent L4 profile and underwent a Medical Evaluation Board (MEB).  The chronic back pain was found medically unacceptable and forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated “chronic thoracic and low back pain” as unfitting, rated it 10%.  The CI made no appeals and was medically separated.

CI’s CONTENTION:  “Degenerative disc disease was not given more consideration.  Disability was based on GERD – later diagnosis of celiac disease and GERD.”

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.  No other conditions are within the DoDI 6040.44 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 20040526	VA – (1 mo. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Back Pain	5237	10%	Degenerative Disc Disease	5243	0%	20040922	
Other x 0 (Not in Scope)	Other x 4 (Not in Scope)		
Combined:  10%	Combined:  10%	
Derived from VA Rating Decision (VARD) dated 20060304 (most proximate to date of separation [DOS])

ANALYSIS SUMMARY:

Chronic Back Pain.  This CI has had a long history of back pain.  At times he complained of thoracic back pain, but mostly his pain was low back pain (LBP).  He had multiple imaging studies and consults with specialists.  Magnetic resonance imaging of the lumbar spine showed congenital anomalies at L4-L5 consistent with lack of segmentation or partial bony fusion.  No herniated disc or degenerative bony changes were seen.  In spite of all diagnostic efforts, the cause of the back pain was uncertain.  In fall of 2003, the CI requested MEB.  The narrative summary was dictated on 1 April 2004, but the MEB physical examination (PE) was performed in November 2003.  At that exam, there was full and symmetric range-of-motion (ROM) in all extremities.  Muscle strength was normal (5 out of 5).  Straight leg raise (SLR) was negative.  There was no tenderness to palpation of the spine or paravertebral muscles.  Specific measurements for thoracolumbar ROM were not recorded.  The CI denied any paresthesia or weakness of any extremity.  The CI was medically separated from service in August 2004.  Six weeks later, he had a VA Compensation and Pension (C&P) exam.  The CI reported that his LBP was continuous and was the same every day.  He denied any numbness or weakness.  Posture, gait and spinal curvature were normal.  The spine was not painful with motion.  PE of the back revealed no objective evidence of painful motion, spasm, weakness or tenderness.  Thoracolumbar ROM was measured and is summarized in the chart below.

Thoracolumbar ROM
(Degrees)	VA C&P ~ 6 weeks Post-Sep
(20040922)	
Flexion (90 Normal)	90	
Extension (30)	30	
R Lat Flexion (30)	30	
L Lat Flexion (30)	30	
R Rotation (30)	30	
L Rotation (30)	30	
Combined (240)	240	
Comment	No painful motion	
§4.71a Rating	0%	

The Board directs attention to its rating recommendation based on the above evidence.  The PEB and the VA chose different coding and rating options for the back pain condition.  The September 2004 C&P exam was performed just 6 weeks after separation and therefore had significant probative value.  At that exam, the CI’s posture, gait, spinal curvature and thoracolumbar ROM were all normal.  There was no pain with motion.  Physical examination of the back revealed no objective evidence of painful motion, spasm, weakness or tenderness.  The Board also considered the matter of peripheral neuropathy.  After reviewing all available evidence, there was insufficient evidence of a clinically significant neuropathy that interfered with performance of military duties.  Therefore, the Board concluded that there was no unfitting radiculopathy present at the time of separation.  The Board determined that IAW the VA Schedule for Rating Disabilities (VASRD) §4.71a, the chronic back pain condition was essentially non-compensable.  However, IAW DoDI 6040.44, the Board is not permitted to reduce the disability rating assigned by the PEB.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends no change in the PEB adjudication of the chronic back pain condition.

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 chronic back pain condition and IAW DoDI 6040.44, 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 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-2013-01921.

	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