RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2013-01927
BRANCH OF SERVICE:  AIR FORCE	BOARD DATE:  20150203
SEPARATION DATE:  20050524

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-6 (Aircraft Hydraulic Systems) medically separated for 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 P2/L4 profile and referred for a Medical Evaluation Board (MEB).  The “back pain” was forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123.  The MEB also forwarded one other condition (“tremors”) for PEB adjudication.  The Informal PEB found the “lumbar strain, with chronic pain” unfitting, and rated it 20%.  The remaining condition was determined to be Category II (a condition that can be unfitting, but not currently compensable or ratable).  The CI made no appeals and was medically separated.

CI’s CONTENTION:  The CI elaborated no specific contention in his application.

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 Veterans Affairs Schedule for Rating Disabilities (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:

Air Force IPEB – dated 20050411	VA* – (~2 mos. Pre-Separation) 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Lumbar Strain	5237	20%	Degenerative Disease of Spine	5242	10%	20050317	
Other x 1 (Not In Scope)	Other x 10	
RATING:  20%	RATING:  30%	
*Derived from VA Rating Decision (VARD) dated 20050615 (most proximate to date of separation (DOS))

ANALYSIS SUMMARY:

Low back pain (LBP).  In 1995, while lifting something heavy, this CI injured his back.  Since then, he was bothered by episodic LBP.  Sometimes the pain would radiate into his buttocks and legs, especially the right leg.  In March 2004, magnetic resonance imaging showed degenerative disc disease at L1-L2 and L2-L3, but no disc herniation was identified.  There was also no significant canal stenosis (narrowing) or foraminal stenosis.  On 26 April 2004, the CI was seen by a neurosurgeon, who determined that back surgery was not warranted.  The CI was treated with physical therapy, medications, and epidural steroid injections.  However, in spite of treatment the LBP persisted and MEB was initiated.  The MEB narrative summary was dated 1 February 2005.  At the MEB physical examination (PE), the CI was alert and in no apparent distress.  The back had several areas of slight (minimal) tenderness.  No back spasm was noted.  Straight leg raise (SLR) was negative bilaterally.  Muscle strength was normal.  Range-of-motion (ROM) of the back was not recorded. The diagnosis of the back was back pain, currently controlled with activity modification and medication.

On 17 March 2005, 10 weeks before separation, the CI had a VA Compensation and Pension (C&P) exam.  Posture and gait were normal.  PE of the back revealed no tenderness or muscle spasm.  There was no radiation of pain with movement, and SLR was negative.  Back ROM was measured and is summarized in the chart below.  With repetitive use, there was no additional limitation due to pain, fatigue, weakness, lack of endurance, or incoordination.  There was no intervertebral disc syndrome.  Neurological exam was normal.  The examiner’s diagnosis of the back was: “Thoracolumbar degenerative disease.”  The ROM evaluation which the Board weighed in arriving at its rating recommendation, is summarized in the chart below.

Thoracolumbar ROM
(Degrees)	VA C&P ~2 mos. Pre-Sep
(20050317)	
Flexion (90 Normal)	90	
Combined (240)	210	
§4.71a Rating	10%	

The Board carefully reviewed the data from the back examinations noted above, and directed attention to its rating recommendation.  The March 2005 C&P exam was just 10 weeks prior to separation, and therefore had significant probative value.  At that exam, forward flexion was 90 degrees, and combined thoracolumbar ROM was 210 degrees.  IAW the VASRD §4.71a General Rating Formula for Diseases and Injuries of the Spine, a 10% rating is warranted when combined thoracolumbar ROM is greater than 120 degrees, but not greater than 235 degrees.

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.  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 DoDI 6040.44 (which prohibits the Board from lowering the rating assigned by the PEB), the Board found insufficient cause to recommend a change in the PEB adjudication of the chronic back condition (“Lumbar strain, with chronic pain”).

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 back pain condition (“Lumbar strain, with chronic pain”) 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 20131022, 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 (Title 10 U.S.C. § 1554a), PDBR Case Number PD-2013-01927.

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