RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00616
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20070628

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a Reserve E5, Chaplain Assistant, medically separated for “chronic low back pain” with a disability rating of 20%.  

CI CONTENTION:  The CI made no specific contention in their application.  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 - 20070515	VARD - 20071109	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5243	20%	Degenerative Disc Disease …	5242	20%	20070822	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s back condition began in May 1993, while lifting and breaking down tents materials during a readiness exercise.  The CI felt a “pop” while bending and twisting with a sudden onset of pain.  The CI recovered with only mild residual pain that was not significantly physically limiting.  Radiographic studies (MRI) on 14 December 2001, showed normal L1-L5 with L5-S1 showing broad based right disc bulging, with no evidence of central or foramen stenosis.  Follow-up radiographic study on May 2004, showed mild diffuse arthritic patterns with slight joint space narrowing mainly at L5-S1 with minimal central disk bulging at L5-S1.  On 21 July 2005, radiographic study (MRI) showed L4-5 and L5-S1 had mild based posterior bulging discs.  
According to the treatment records, on 19 September 2006 (9 months prior to separation), a VA outpatient clinic sent a letter detailing that the CI continued to have daily lumbar pain, limited level of activity with exercise and range of motion (ROM), and minimal relief of her chronic pain.  The CI was treated with muscle relaxers, narcotic pain medication and a TENS unit [Transcutaneous Electrical Nerve Stimulation – device to reduce pain transmission].  

According to the pain management clinic, on 28 September 2006 (9 months prior to separation), the CI reported pain in the midline and right paramedian low back with radiation in a band-like distribution from the lower back to the right hip, buttock and from the posterior leg to above the knee.  On examination, flexion is mildly uncomfortable with extension, lumbar rotation and lateral flexion to the right produced pain and paraspinal muscles were non tender.  Deep tendon reflexes were 2/4 bilaterally with light tough intact, bilaterally to lower extremities.  

Despite treatment, the CI’s back pain could not be adequately treated to meet the physical requirements of the CI’s military specialty and was referred for a MEB.  

The ROM examinations 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 ~2 Mo. Pre-Sep	VA C&P ~2 Mo. Post-Sep	
Flexion (90 Normal)	60	80	
Combined (240)	190	225	
Comment	Normal gait; tenderness; painful motion; painful heel walk	Normal gait; no spasm; complained of pain at end point with forward flexion and right lateral rotation; no change with repetitive motion	
§4.71a Rating	20%	10% (VA 20%)	

At MEB NARSUM examination on 27 February 2007 (4 months prior to separation), the CI reported discomfort on sitting, standing, or lying for long periods of time.   Annotation in the CI’s service record showed complaints of intermittent pain and muscular spasms continued since the initial injury.  The examination referenced the pain management clinic exam dated 28 September 2006 (9 months prior to separation) noted above.  

At the VA Compensation and Pension (C&P) examination on 22 August 2007 (2 months after separation) the CI reported low back pain with prolonged sitting/standing and reclining.  Pain was reported at 8-9/10 on the pain scale.  The CI reported utilizing a TENS unit and pain medications (non-narcotic).  The CI denied radiation of back pain, flares, or problems that interfere with daily activity.  On examination, deep tendon reflexes were 2+ knee jerk and ankle jerk, straight leg raise was to 80 degrees bilaterally without pain, toe extensors were strong and sensation intact to light-touch both feet, motor exam was intact with tenderness over the right hip.  Radiographic studies showed moderate narrowing of L5-S1 disk space.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 20% rating under the 5243 code (intervertebral disc syndrome), citing discomfort with prolonged sitting, standing, and lying.  The VA also assigned a 20% rating using the 5242 code (degenerative arthritis of the spine), citing retention of a prior rating as sustained improvement had not been definitively established.  

The Board agreed that there was not sufficient evidence of limitation of forward flexion of the thoracolumbar spine 30 degrees or less; or, ankylosis to justify any rating higher than 20%.  There was no documentation of intervertebral disc syndrome with incapacitating episodes which would provide for a higher rating under that formula or evidence of ratable peripheral nerve impairment which would provide for additional rating.  There was no associated radiculopathy for separate peripheral nerve rating.  Although the CI experienced radiating pain, there was no objective evidence of a radiculopathy or functional impairment with a direct impact on fitness.  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 is no evidence in this case that there was radiculopathy with associated functional impairments separately functionally impairing.  The Board therefore concludes 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 back condition.  

BOARD FINDINGS:  In the matter of the 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 20140117, w/atchs
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-2014-00616.

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