RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00935
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20080804

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Personnel Craftsman, medically separated for “lumbago” with a disability rating of 10%.  

CI CONTENTION:  The CI request reconsideration of her rating under guidelines of the Wounded Warrior Act.  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 based upon a 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 – 20080606	VARD – 20090128	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Lumbago	5243	10%	Degenerative Disc Disease, Thoracolumbar Spine, with Lumbago and a History of Radiculopathy	5243	10%	20080808	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:  

Lumbago.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s back condition began in 2002 while pregnant.  Re-injury occurred in 2005 after an automobile accident.  Radiographic imaging (MRI) in June 2006 revealed an L5-S1 disc protrusion with some mild narrowing of the right foramen, and minimally impinging the S1 nerve root.  The CI was referred for neurosurgery consultation in April 2007, however, there was no surgical indication based on the MRI findings.  Electrophysiologic studies demonstrated no lower extremity radiculopathy.  Conservative treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “lumbago” for PEB adjudication.  

At a PT visit in January 2008, 6 months pre-separation, the examiner documented forward flexion of 65 degrees (normal 90); pain was not addressed.  At an MEB appointment in March 2008, 4 months pre-separation, the CI indicated improvement in her pain with limited exercise and denied paresthesias.  The MEB NARSUM examination, 3 days later, noted continued complaints of low back pain with tingling in the lower extremities.  Physical examination indicated full range of motion (ROM) without pain.  Straight leg raise testing indicated no radiculopathy.  Strength and reflexes were normal bilaterally.  Radiographic studies in July 2008 showed no significant changes from prior studies.  There was no documentation of incapacitating episodes requiring physician prescribed bed rest.  There was no documentation of more significantly limited ROM deficits.  

At the VA Compensation and Pension (C&P) examination in August 2008, 4 days post-separation, the CI reported stiffness, weakness, and constant pain radiating to her right thigh.  She reported three incapacitating episodes in the previous year lasting approximately 1-2 days each.  Physical examination revealed normal gait, and normal curvature of the spine.  There was painful motion, tenderness at the lumbosacral junction, with no muscle spasm and no radiating pain.  Provocative maneuvers for radiculopathy were negative.  Thoracolumbar ROM showed flexion of 70 degrees (normal 90) after repetition, limited by pain.  

The Board directed attention to the rating recommendation based on the above evidence.  Both the PEB and VA assigned a 10% rating under 5243 code (intervertebral disc syndrome), with the VA citing limitation of forward flexion.  

The Board agreed that a 10% rating, but no higher, was justified for limitation of flexion (greater than 60 degrees but not greater than 85 degrees) reported on all examinations proximate to separation.  There was no muscle spasm or guarding severe enough to result in an abnormal gait or spinal contour, thus the next higher 20% rating was not justified on this basis.  Although the CI reported incapacitating episodes, there was no evidence of intervertebral disc syndrome (IVDS) which resulted in incapacitating episodes requiring physician-prescribed bed rest to warrant a higher rating than 10%.  

The Board also considered if additional disability rating was justified for peripheral nerve impairment due to radiculopathy.  Electrodiagnostic studies documented no radicular nerve irritation or involvement, and physical examinations (Neurosurgery, PT, MEB NARSUM, and VA C&P) proximate to separation revealed no objective findings of radiculopathy that would impact duty performance.  The presence of functional impairment with a direct impact on fitness is the key determinant in the Board’s decision to recommend any condition for rating as additionally unfitting.  While the CI may have suffered additional pain from the nerve involvement, this is subsumed under the general spine rating criteria, which specifically states “with or without symptoms such as pain (whether or not it radiates).”  Therefore the critical decision is whether or not there was a significant motor weakness which would impact military occupation-specific activities.  There was no evidence in this case that motor weakness existed to any degree that could be described as functionally impairing.  The Board therefore concluded that an 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 lumbago condition.  

BOARD FINDINGS:  In the matter of the lumbago 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 20140220, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAF/MR

Dear XXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2014-00935.

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