RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00632
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20060130

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty O3, Trainer Pilot, medically separated for “chronic back pain, status post L3-L4 discectomy” with a disability rating of 10%.  

CI CONTENTION:  The CI contends the PEB did not take into account other issues such as “leg pain, nerve damage, stenosis, spondylosis and disc bulges.”  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 - 20051208	VARD - 20070720	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Back Pain, Status Post L3-L4 Discectomy	5243	10%	DDD of the Lumbar Spine…	5243	10%	20070131	
			Radiculopathy of the LLE	5243-8520	10%	20070131	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Chronic Back Pain, Status Post L3-L4 Discectomy.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent back surgery in August 2005 for multi-level degenerative disc disease (DDD).  Following surgery, rehabilitation did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “severe multilevel lumbar spondylosis with annular tears at L3 through S1” and “chronic low back pain (LBP) despite surgery in Aug 05” for PEB adjudication.  The MEB NARSUM examination on 01 November 2005 (3 months prior to separation) noted complaints of severe back pain but “90% relief of his left lower extremity pain.”  On examination, there was pain and limitations to range of motion (ROM), but the motor and sensory evaluations were normal.  An orthopedic evaluation on 31 August 2006 noted ongoing left lower extremity (LLE) pain from the back.  He was active in swimming and cycling.  The CI had a normal gait, neurological examination, and ROM.  Atrophy was absent and provocative nerve root testing was negative.  At the 31 January 2007 VA Compensation and Pension (C&P) evaluation, performed 12 months after separation, the CI reported chronic LBP with radiation to LLE aggravated by prolonged standing, running, jogging, bending, stooping and lifting heavy weight.  The CI was able to walk on his heels and toes and squat.  There was “no pain on range of motion, loss of motion on repeated maneuver.”  The same day, a neurological examination was normal, other than an absent left knee reflex, as was the gait.  Atrophy was absent.  Motion was pain free, but flexion reduced to 70 degrees (normal is 90) and the combined ROM was 195 degrees (normal is 240).  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the back pain condition 10% coded 5243 (intervertebral disc syndrome), citing the CI’s medical condition was not compatible with the rigors of military service.  The VA also rated the back pain condition 10% coded 5243 (intervertebral disc syndrome), based on the VA C&P examination 12 months after separation, citing limitation of forward flexion.  Board members debated if a rating higher than the PEB’s 10% was warranted.  The next higher 20% rating required flexion greater than 30 degrees but not greater than 60 degrees, combined ROM not greater than 120 degrees, or muscles spasms or guarding severe enough to cause an abnormal gait or spinal contour.  Since none of these stipulations were present, a 20% rating was not justified.  There was no documentation of intervertebral disc syndrome (IVDS) with incapacitating episodes which would provide for a higher rating under that formula (for IVDS), or evidence of an unfitting radiculopathy which would provide for additional 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 chronic back pain condition.  

BOARD FINDINGS:  In the matter of the chronic low back condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended left leg 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.  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 20140127, 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-2014-00632.

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