RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX		CASE:  PD-2014-00317
BRANCH OF SERVICE:  AIR FORCE	SEPARATION DATE:  20071124

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a traditional drilling Reserve E-6 (Security Forces) medically separated for low back pain.  The condition could not be adequately rehabilitated to meet the physical requirements of his Air Force Specialty (AFS).  He was issued a temporary P4 profile and referred for a Medical Evaluation Board (MEB).  The “back pain, mild hypertension” were forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123.  No other condition was submitted by the MEB.  The Informal PEB (IPEB) adjudicated the low back pain condition as unfitting, rated 10% citing application of the DoD and Veterans Affairs Schedule for Rating Disabilities (VASRD) guidelines.  The hypertension condition was determined to be not unfitting.  The CI appealed to the Formal PEB (FPEB), which increased the rating to 20% citing application of the VASRD.  The CI made no further appeals, and was medically separated.  

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

FPEB – Dated 20070807	VA* - based on Service Treatment Records (STR)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Low Back Pain	5243	20%	Low Back Condition	5237	NSC	STR	
Other MEB/PEB Conditions x 1 (Not In Scope)	Other x 10	
RATING:  20%	RATING:  N/A	
*Derived from VA Rating Decision (VARD) dated 20080718 (most proximate to date of separation [DOS])

ANALYSIS SUMMARY:

Low Back Condition.  According to notes in the STR and the narrative summary (NARSUM) the CI had a history of low back pain (LBP) and radiating pain to the right lower extremity (LE) since January 2003 after lifting a file cabinet.  The CI was evaluated by a pain management specialist and treated medically.  The CI was selected for deployment in June 2006 and reported the ongoing back pain.  The CI was given a 4T profile 3 June 2006, which noted he was “not deployable."  Magnetic resonance imaging 3 August 2006 showed degenerative disc disease at multiple levels and a small disc protrusion on the right at L5-S1, which abutted the S1 nerve root.  The CI was evaluated by a neurosurgeon and continuation of conservative treatment was recommended.  The CI was treated with physical therapy (PT) and given two epidural steroid injections (ESI) with significant improvement.  At a primary care visit in January 2007, the CI reported he was doing very well after the ESIs and had no complaints.  The CI was referred for an MEB according to Air Force instructions because an assignment was canceled due to a medical condition.

At the MEB NARSUM examination, 1 March 2007, 9 months before separation, the CI reported intermittent LBP, but no LBP or LE symptoms at the time of the exam.  The exam noted a normal gait, with no spinal tenderness or deformity.  Back flexion was reported as “at hips 80 degrees” and “touches fingertips to lower ankles without difficulty.  At a PT follow-up visit on 14 March 2007 the CI reported intermittent LBP.  The exam noted flexion of 50 degrees with pain “now centralized to the spine” and straight leg raise testing (SLR) was negative bilaterally.

At the VA Compensation and Pension (C&P) exam 3 months after separation, the CI reported constant LBP, without radiation or flare-ups.  He reported there had been no episodes of physician prescribed bed rest for the back condition in the past 12 months.  The exam noted normal posture and gait.  There was normal spine curvature without tenderness or muscle spasm.  Lumbar flexion was 80 degrees (normal 90) with combined range-of-motion (ROM) of 180 degrees (normal 240).  There was no evidence of painful motion and no additional loss of ROM with repetition.  There was negative SLR bilaterally.  Strength, sensation, and reflexes of the bilateral LEs were normal and the CI was able to heel and toe walk without difficulty.  

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB rated the low back condition 20%, coded 5243 (intervertebral disc syndrome).  The original VARD did not service-connect the back condition due insufficient service medical records provided by the CI.  The later VARD 18 September 2013 did service-connect the low back condition and rated it 10% with an effective date of 18 May 2012.  The Board noted that the PT visit 2 weeks after the MEB exam supports a 20% rating according to the VASRD General Formula for Rating the spine in effect on the date of separation for thoracolumbar (TL) flexion of 50 degrees, while the MEB exam supports a 10% rating.  Thus, the PEB provided the higher of two evaluations consistent with VASRD §4.7 (higher of two evaluations).  Therefore, the Board reviewed to see if the next higher evaluation than 20% was supported, but there was no evidence of TL flexion of “30 degrees or less.”  The Board reviewed to see if a higher evaluation than 20% was achieved coding with 5243 and rating based on incapacitating episodes, defined by the VASRD as bed rest prescribed by a physician and treatment by a physician.  However, there was no documentation in record of incapacitating episodes as defined.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the low back condition.  

The Board also considered if there was evidence in the record to support recommending the LE symptoms as separately unfitting and eligible for additional disability rating.  Proximate to separation the CI had reported LE radicular pain, but strength, sensation, and reflexes were normal throughout the record and the three exams above (MEB exam, PT exam, and C&P exams) noted localized back pain without radiation.  The pain component of a radiculopathy is subsumed under the general spine rating as specified in §4.71a and since no evidence of a motor or sensory deficit associated with functional impairment exists in this case, the Board cannot support a recommendation for additional rating based on peripheral nerve impairment.

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 20140107, 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

XXXXXXXXXXXXXXX
XXXXXXXXXXXXXXX
XXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2014-00317.

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,

								XXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings