RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2014-00402
BRANCH OF SERVICE:  AIR FORCE	SEPARATION DATE:  20070423

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-6 (Aerospace Maintenance Craftsman) medically separated for a low back pain.  The condition could not be adequately rehabilitated to meet the physical requirements of his Air Force Specialty (AFS) or satisfy physical fitness standards.  He was issued a temporary L4 profile and referred for an Medical Evaluation Board (MEB).  The “chronic lower back pain” was forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123 No other condition was submitted by the MEB.  The Informal PEB (IPEB) adjudicated “low back pain due to degenerative disc disease status post-surgery” as unfitting, rated 20%, citing application of Department of Defense and Veteran’s Affairs Schedule for Rating Disabilities (VASRD) guidelines.  The CI made no appeals and was medically separated.  

CI CONTENTION:  He was given a higher rating for his back condition by the VA.  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 condition 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:  

Service IPEB – Dated 20070221	VA* - (~3 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Low Back Pain…	5243	20%	DDD/DJD Lumbar Spine	5242	20%	20070717	
			Residual Scar, Lumbar Spine	7804	10%	20070717	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 2	
RATING:  20%	RATING:  40%	
*Derived from VA Rating Decision (VARD) dated 20071010 (most proximate to date of separation [DOS])

ANALYSIS SUMMARY:  

Low Back Pain and Degenerative Disc Disease (DDD).  The service treatment record (STR) first documented low back pain (LBP) in November 2002 (10 years after entry).  Radiographic imaging in December 2002 (and subsequently in March and September 2005) documented multilevel DDD.  Neurosurgery was consulted in January 2003 (4 years pre-separation) and a nerve root injection was performed in February 2003 with some relief.  An MEB was completed in February 2003 and the CI was returned to duty.  His back pain continued with increased radiation to the lower extremities.  In April 2005 (2 years prior to separation), an L5-S1 laminectomy (decompression) surgery was performed for radicular pain with some resolution of his lower extremity symptoms.  There were no STR entries until an emergency room visit in September 2005 for a “pinched nerve.”  The pain persisted after several interventions (medications, steroids, physical therapy, and electrical stimulation).  Multiple STR entries (in March, August, October, and December 2006) documented painful motion with no muscle spasm, normal reflexes, and normal strength.  There were 2 entries in October 2006 that documented full range-of-motion (ROM).  There were 3 entries that documented normal posture (in August, November, December 2006) and 2 entries that documented abnormal posture (in October 2006).  

At the MEB narrative summary (NARSUM) exam (dated 13 December 2006 and 4 months pre-separation), the CI reported taking multiple medications for pain “as needed,” and some improvement; however, he still had “limitations at his work on and off due to pain.”  The examiner documented tenderness to palpation along the lumbosacral musculature bilaterally, and decreased ROM due to pain with flexion, rotation and extension.  There was a normal gait, normal strength bilaterally, and symmetric reflexes.  Physical therapy ROMs were obtained on 23 January 2007 (3 months pre-separation); painful motion was documented.  Thoracolumbar flexion was 50 degrees (normal 90), extension 20 degrees (normal 30), right and left lateral flexion 20 degrees (normal 30), with right and left rotation 25 degrees (normal 30).  A follow-up visit with neurosurgery (dated 23 January 2006 and 3 months pre-separation), the CI reported continued pain in the lower back, and numbness and tingling of the right leg without weakness.  The examiner documented normal gait and strength of the lower extremities with a diagnosis of lumbar disc degeneration.  No surgical options were discussed or recommended.  There was no STR documentation of more significant ROM limitations, neurological deficits, or periods of incapacitation necessitating physician prescribed bed rest.  

At the VA Compensation and Pension (C&P) exam (dated 17 July 2007 and 3 months post-separation) the CI reported constant daily “back pain radiating to his left mid-thigh,” occasional use of a cane, and that he was taking medications as needed.  He reported being self-employed as a woodworker and estimated about 3 weeks of work lost in the last year due to “decreased mobility, problems with lifting and carrying, and pain.”  The back pain limited his standing to 15-30 minutes and walking was limited to 1-3 miles.  His back pain had moderate effect on performing chores, shopping and traveling; a severe effect with exercise and recreation; and prevented him from participating in sports.  He denied any bowel or bladder issues related to the back.  The examiner documented a normal gait, without spasm or abnormal curvature of the lumbosacral spine.  The thoracolumbar spine exhibited painful motion and a forward flexion of 50 degrees, extension 12 degrees; right lateral flexion of 12 degrees and left lateral flexion of 20 degrees; and bilateral rotation to 35 degrees.  There was no muscle spasm or guarding or any additional loss of motion with repetition.  There were signs of nerve tension on the left (positive straight leg raise) with normal reflexes, sensation and tone.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB adjudicated the low back pain and degenerative disc disease as unfitting, rated 20% coded as 5243 (lumbosacral strain).  The VA rated 20% coded 5242 (degenerative arthritis of the spine).  There was STR and VA documentation of painful motion, intermittent abnormalities of gait, and ROM deficits to support a 20% rating.  There were no periods of incapacitating episodes which would provide for a higher rating under that formula.  There was no evidence in this case that motor weakness or sensory impairment existed to any degree that could be described as functionally impairing, and therefore, no evidence for an additional or higher rating.  There was no STR documentation of ankylosis or thoracolumbar flexion to 30 degrees to warrant a higher rating under that formula.  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.  

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.  As discussed above, PEB reliance on Department of Defense guidelines for rating the back condition was operant in this case and the condition was adjudicated independently of that instruction by the Board.  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 20140103, 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-2014-00402.

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 

cc:
SAF/MRBR