RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00982
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20090629

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E5, Communication Signals Intelligence Analyst, medically separated for “low back pain,” with a disability rating of 10%.  

CI CONTENTION:  The applicant contended her back condition had worsened.  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 - 20090420	VARD - 20130301	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5243	10%	Degenerative Disc Disease of the Lumbar Spine and Lumbar Strain	5237	10%	20130205	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s low back condition began in August 2005 after delivering her baby.  At the time of the initial family practice clinic appointment on 29 August 2006, the CI reported low back pain radiating to her legs.  The examiner recorded lumbar muscle spasm and painful motion.  A magnetic resonance imaging (MRI) of the lumbar spine in November 2006 showed L4-L5 disk bulge associated with an annular tear.  The CI underwent a 3 year course of physical and chiropractic therapy and pain management treatment.  At the family practice clinic appointment on 31 July 2008, the CI reported persistent lower back pain.  The examiner noted lumbar spine tenderness and spasms (L4 and L5) but no lower extremity weakness.  In August 2008, (10 months prior to separation), the CI underwent a series of epidural steroid injections.  Despite pain management treatment, there was no change noted in her symptoms.  At the examination by the neurosurgery clinic on 04 November 2008, (7 months prior to separation), the CI reported low back pain which radiated into the left leg.  The examiner concluded the CI had normal reflexes, motor strength and no neurological findings and recommended nonsurgical treatment.  There was no surgical indication, and conservative treatment did not result in improvement sufficient to allow unrestricted duty and the CI was referred for an MEB.  

The MEB NARSUM physical examination on 01 December 2008 (6 months prior to separation), noted the CI had chronic low back pain of “variable intensity and was restricted in her mobility, using minimal medication in management of her pain, and instead relied on physical therapy and chiropractic manipulation.”  On examination both sides of the lower back region had tenderness.  The CI had normal motor strength and straight leg raise test.  There was “no deformity or abnormal curvature” of the spine.  The examiner concluded that the CI was able to remain on active duty within the “restrictions imposed by her back pain.”  During the MEB physical therapy examination on 11 December 2008, (6 months prior to separation) the CI reported sharp shooting pain down her left leg.  Thoracolumbar ROM measurements recorded, active flexion to 70 degrees (normal 90), and a combined ROM of 185 degrees (normal 240) after repetitive motion.  The MEB Addendum on 08 January 2009 (3 months prior to separation) noted the original MEB assessment recorded on 01 December 2008 remained unchanged and the examiner stated the CI was “able to contribute materially to the Air Force.”  At the request of the CI for her MEB rebuttal letter, the family practice clinic on 26 January 2009 documented that the CI had been placed on quarters for her back pain from 13 January through 17 January 2009 (within the last 90 days).  Previously, the CI was placed on quarters for 2 days in July 2008 (within the past 12 months).  An MRI performed in January 2009 showed normal alignment of the lumbar spine and stable L4-5 and L5-S1 disk bulges without spinal nerve root compression.  At the orthopedic examination on 07 MAY 2009 (1 month prior to separation) noted the CI’s lumbar spine had painful motion, tenderness, spasm, and a normal gait.  The orthopedic examiner documented the CI’s trunk flexion ROM as her ability to reach her finger tips to the floor, which approximates 90 degrees (normal) of thoracolumbar flexion.  

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 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 the MEB physical therapy examination proximate to separation.  Although there was muscle spasm documented, it was not severe enough to result in an abnormal gait or spinal contour, thus the next higher 20% rating was not justified on this basis.  Because the PEB rated the CI’s “chronic low back pain” as intervertebral disc syndrome (IVDS) coded 5243, the Board considered whether a higher rating (§4.7) was achieved by using the alternate rating formula based on incapacitating episodes.  According to review of the STR, there was no documentation of IVDS with incapacitating episodes which would provide for a higher rating under that formula for IVDS.  According to review of the STR, the total duration of incapacitation over the 12 months prior to separation was at least 1 week, but less than 2 weeks supporting a 10% 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 lower 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 20140219, 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-2014-00982.

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