RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00520
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20050118	

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Aircraft Armament Systems Craftsman, medically separated for “chronic low back pain associated with degenerative disk disease” with a disability rating of 10%.

CI CONTENTION:  The CI asks the Board to consider medical retirement.  The CI’s complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The Board’s scope of review is defined in Dodi 6040.44.  It is limited to those conditions determined by the Physical Evaluation Board (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 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:  

SERVICE PEB - 20041115	VARD - 20051117	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain associated with Degenerative Disk Disease	5243	10%	Lumbosacral Injury with Disc Herniation	5237	10%	20050616	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain (LBP) associated with Degenerative Disk Disease (DDD).  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s lower back condition began in 1996 after lifting heavy ordnance.  Magnetic resonance imaging (MRI) studies on 6 January 2003 showed mild DDD with slight L4-L5 disc herniation to the left, without central spinal canal stenosis or nerve impingement.  A physical medicine examination on 29 December 2003 showed a normal gait, normal heel to toe walk, “free range of motion for flexion, extension, lateral rotation,” and straight leg raise testing (SLR) to elicit radicular symptoms was negative.  At the time of the neurosurgical clinic appointment on 5 January 2004, the CI reported episodic LBP over the course of many years.  He reported “typical” pain graded as 2-3/10 that occurred after standing for approximately 1 hour.  The physical examination noted range-of-motion (ROM) as “adequate” but did elicit pain.  The examiner recorded intact sensation and strength graded 5/5 in all muscle groups bilaterally.  The CI was able to stand on his heels and toes.  Surgery was discussed but noted that unless the CI’s symptoms increased, continued conservative management was recommended.  

The MEB NARSUM examination on 25 October 2004 (4 months prior to separation) noted LBP low back pain with mild numbness and pain in the left buttock that occasionally radiated down the posterior left lower extremity.  Physical examination showed “slightly antalgic gait” and “decreased range of motion with somewhat mild tenderness in the lumbar muscles.”  Lower extremity strength, sensation, and reflexes were normal and SLR was negative.  

At the 16 June 2005 VA Compensation and Pension (C&P) evaluation, performed 4 months after separation, the CI reported constant 5-6/ LBP, with occasional radiation of pain into the left leg.  He reported some stiffness but no weakness.  He could walk a mile before pain and occasional spasms began, and used no assistive devices.  Physical examination showed a normal gait.  There was TTP without muscle spasm.  There was negative SLR bilaterally with 5/5 muscle strength and normal LE sensation.  Back ROM examination was forward flexion of 0-90 degrees with pain, 20 degrees extension with pain, and normal (30 degrees) lateral flexion and rotation with pain at the extremes.  There was no decrease in the ROM of these movements after repetition, but increase in pain and fatigue was noted.  Lumbar X-rays revealed a narrow disc space between L5/S1 and minimal arthritis.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the lower back condition 10% coded 5243 (intervertebral disc syndrome).  The VA also rated the lower back condition 10% coded 5237 (lumbar spine strain), based on the VA C&P examination 4 months after separation, citing limitation of motion with pain.  The evidence does not support a rating higher than the PEB 10% rating.  The next higher 20% rating requires flexion greater than 30 degrees but not greater than 60 degrees, or combined ROM not greater than 120 degrees, or muscles spasms or guarding severe enough to cause an abnormal gait or spinal contour and none of these criteria were present.  The Board considered whether a higher rating (§4.7) was achieved by using the alternate rating formula based on incapacitating episodes due to intervertebral disc syndrome.  Although the CI had intervertebral disc disease there were no incapacitating episodes requiring bed rest prescribed by a physician to warrant consideration of rating under the alternate VASRD formula based on incapacitating episodes.  There was no associated radiculopathy for separate peripheral nerve rating.  While the CI may have experienced radiating pain from the back condition, this is subsumed under the general spine rating criteria, which specifically states “with or without symptoms such as pain (whether or not it radiates).”  There was no objective evidence of a radiculopathy with functional impairments such as weakness with a direct impact on fitness that were separately functionally impairing for duty.  The Board therefore concluded that additional disability rating was not justified on this basis.

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 chronic low back condition.

BOARD FINDINGS:  

In the matter of the lower 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.  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 20140121, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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

Dear XXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2014-00520.

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