RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00272
BRANCH OF SERVICE:  AIR FORCE 	SEPARATION DATE:  20080808

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-3, Health Service Management Apprentice, medically separated for a back condition.  The back condition could not be adequately rehabilitated to meet the physical requirements of her Air Force Specialty (AFS) or satisfy physical fitness standards.  She was issued an L4 profile and referred for a Medical Evaluation Board (MEB).  “Lumbago” 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 low back pain, with small central protrusion of L4-5” as unfitting, rated 10%, citing application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated. 

CI CONTENTION:  She was given a higher rating for her condition by the VA.  Her complete submission is at Exhibit A. 

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 20080618	VA* - (~4.5 years Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain, with Small Central Protrusion of L4-5	5243	10%	Degenerative Disc Disease of the Lumbar Spine	5242	10%	20130320	
			Radiculopathy, Right Lower Extremity Associated with Degenerative Disc Disease of the Lumbar Spine	8520	10%	20130320	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 4	
RATING:  10%	COMBINED RATING:  40%	
*Derived from VA Rating Decision (VARD) dated 20130517 (most proximate to date of separation (DOS)).  

ANALYSIS SUMMARY:  

Low Back Condition.  The CI presented in March 2007 with reports of low back pain, bilateral leg pain, leg weakness, and right leg numbness after a motor vehicle accident.  The physical examination demonstrated thoracolumbar tenderness to palpation, painful motion, and negative radiculopathy testing.  She was diagnosed with lumbago.  She was treated with activity modification, muscle relaxing medications, anti-inflammatory medications, and physical therapy without pain relief.  A magnetic resonance imaging study performed 21 June 2007 revealed thoracic and lumbar spondylosis.  A neurosurgery evaluation dated 2 August 2007 documented that surgery was not indicated.  At the narrative summary (NARSUM) examination dated 30 April 2008 the CI reported low back pain radiating down her right leg to her knee with numbness and tingling.  The musculoskeletal and neurologic examinations were normal.  A diagnosis of chronic low back pain-lumbar disc protrusion at L4-5 was rendered.  At the VA Compensation and Pension (C&P) examination performed 4 years after separation, the CI reported daily low back pain described as “an annoying pinch.”  The pain radiated to up her middle back and down her right leg.  The musculoskeletal exam was normal except for thoracolumbar tenderness to palpation.  The examiner noted mild right sciatic nerve radiculopathy.  A diagnosis of thoracolumbar intervertebral disc disease was rendered.  The goniometric range-of-motion (ROM) evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.

Thoracolumbar ROM
(Degrees)	MEB ~3.5 Mo. Pre-Sep
	VA C&P ~4.5 years Post-Sep
	
Flexion (90 Normal)	90	80	
Combined (240)	210	225	
§4.71a Rating	10%	10%	

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB and VA rated the unfitting low back pain condition at 10%; coded 5243 (intervertebral disc syndrome) and 5242 (degenerative arthritis of the spine) respectively.  The ROM recorded by the MEB and VA examinations support a 10% rating based on findings of forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 80 degrees or the combined range-of-motion of thoracolumbar spine greater than 120 degrees but not greater than 235 degrees.  The Board considered whether the evidence supported a rating higher than 10%.  There was no evidence of thoracolumbar forward flexion less than 60 degrees; combined range of motion less than 120 degrees, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour, or incapacitating episodes of back pain totaling at least 2-4 weeks during the past 12 months for 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 pain condition was appropriately recommended in this case.  The Board determined that the preponderance of evidence did not support an unfitting right leg radiculopathy and concluded therefore that this condition could not be recommended for additional disability rating.  The lower extremity pain is appropriately subsumed by the General Rating Formula for Diseases and Injuries of the Spine which incorporates symptoms such as pain whether or not it radiates.

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 pain condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended right leg radiculopathy condition, the Board unanimously agreed that it was not unfitting and is not recommended for additional disability rating.  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 20140104, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD  20762

Dear XXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2014-00272.

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.

Sincerely,

Attachment:
Record of Proceedings