RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXX					    	            CASE:  PD-2014-00579
BRANCH OF SERVICE:  AIR FORCE	SEPARATION DATE:  20070604

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Fuels Apprentice) medically separated for a back condition.  The back condition could not be adequately rehabilitated to meet the physical requirements of his Air Force Specialty (AFS).  He was issued a P4 profile and referred for a Medical Evaluation Board (MEB).  “Chronic low back pain” was forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123.  The MEB also identified and forwarded obstructive sleep apnea for PEB adjudication.  The Informal PEB adjudicated “low back pain radiating to lower extremities, with disc bulge L5-Sl” as unfitting, rated 20%, citing application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  Obstructive sleep apnea was determined to be Category II, a condition which can be unfit, but not compensable or ratable.  The CI made no appeals and was medically separated.  

CI CONTENTION:  He was not evaluated for radiculopathy.  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/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 20070411	VA* - (~4 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
LBP Radiating to Lower…	5243	20%	DDD of the Lumbar Spine (L5-S1)	5243	20%	20070927	
Other MEB/PEB Conditions x 1 (Not In Scope)	Other x 2 	
RATING:  20%	COMBINED RATING:  60%	
*Derived from VA Rating Decision (VARD) dated 20071105 (most proximate to date of separation [DOS]).  

ANALYSIS SUMMARY:  

Low Back Pain Radiating to Lower Extremities, with Disc Bulge at L5-S1.  The record shows that the CI presented in early 2006 with a 3-year history of low back pain (LBP) which he had previously treated with medications and stretching, but now impaired duty.  He denied trauma.  Magnetic resonance imaging (MRI) on 17 August 2006 showed a herniated disc at L3-4, L4-5 and L5-S1 with nerve root impingement.  He was referred to pain management and underwent a series of epidural steroid injections (ESIs) which provided temporary relief.  He was not able to meet duty requirements and was on a temporary L4 profile for over a year.  This and the profile for the obstructive sleep apnea (OSA) mandated referral for an MEB.  The narrative summary (NARSUM) was dated 14 February 2007.  The CI reported that he had initially injured his back in April 2003 from a combination of weight lifting and lifting heavy objects at work.  It was recorded that the CI was not interested in pursuing surgery.  He had reduced range-of-motion (ROM) of the back and a normal neurological evaluation (limited in scope) other than a positive provocative test for nerve root irritation.  A family practice note dated 30 March 2007 documented that the CI had improvement in his LBP since he had lost weight (the 68 inch CI weighed 224 pounds at that visit) and increased his exercise.  He no longer used a cane.  He was observed to have difficulty with postural changes and had a slight limp.  The CI was seen in family practice on 14 May 2007, the last record in evidence prior to separation which was 3 weeks later.  The CI again reported decreased symptoms with weight loss (although actually up 1 pound).  He was noted to have a normal gait and stance, motor function and sensation.  His right knee jerk reflex was decreased (not quantified).  At the VA Compensation and Pension (C&P) examination performed on 27 September 2007, almost 4 months after separation, the CI reported continued, progressive pain but denied incapacitation.  His gait and neurological examinations were normal.  The ROM was reduced and painful as documented below.  There was no further decrease with repetition.  Spasm was absent.  The goniometric 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)	PT ~8 Mo. Pre-Sep	PT ~3 Mo. Pre-Sep	VA C&P ~4 Mo. Post-Sep	
Flexion (90 Normal)	45 w/left shift	40	60	
Combined (240)	195	~160	210	
Comment		Nml gait and transfer; limited by pain	Painful motion	
§4.71a Rating	20%	20%	20%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB and VA both rated the back condition at 20%, coded 5243 (intervertebral disc syndrome).  The Board found no route to a higher rating for the back condition.  The CI also contended for bilateral radiculopathy.  Neither the PEB nor the VA rated this condition at separation.  The neurological examinations both before and after separation which were proximate to separation were normal other than one which showed a diminished knee jerk, a finding of no functional significance.  The VA did add a bilateral lower extremity radiculopathy at 20%, but not until 31 January 2012, over 4 years after separation.  The Board also observed that the CI had two injuries on the job after separation, in November 2009 and November 2011.  The evidence does not support the presence of an unfitting radiculopathy at separation.  The Board concluded therefore that this condition could not be recommended for additional disability rating.  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 pain 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.  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.  In the matter of the contended radiculopathy condition, the Board unanimously agrees that it cannot recommend it 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 20140117, 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

XXXXXXXXXXXX
XXXXXXXXXXXX
XXXXXXXXXXXX

Dear XXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2014-00579.

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,

XXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings