RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXX	CASE:  PD-2014-01106
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20080521

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4, Ground Radio Communications Journeyman, medically separated for “chronic low back pain with lumbar degenerative disc disease with radiculopathy” and “neck pain with degenerative disc disease,” rated 10% and 10%, respectively, with a combined disability rating of 20%.  

CI CONTENTION:  The applicant’s conditions continue to worsen and negatively impact his daily activities.  The applicant’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 PEB to be unfitting for continued military service and when specifically requested by the CI, those conditions identified by the Physical Evaluation Board (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 - 20080404	VARD - 20080703	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain with Lumbar Degenerative Disc Disease with Radiculopathy	5243	10%	Degenerative Arthritis, Thoracolumbar Spine…	5242	10%	20080424	
Neck Pain with Degenerative Disc Disease	5243	10%	Disc Protrusion, Cervical Spine	5299-5243	10%	20080424	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain with Lumbar Degenerative Disc Disease with Radiculopathy Condition.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s lower back pain radiating to the lower extremities began in November 2005 after playing volleyball.  The CI denied any specific injury or trauma.  A magnetic resonance imaging (MRI) study in November 2007 showed a small lumbosacral disc protrusion and degenerative disc disease (DDD).  There was no surgical indication, and conservative treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “chronic low back pain with lumbar degenerative disc disease” for PEB adjudication.  The NARSUM physical examination performed 3 months prior to separation showed bilateral lower lumber tenderness to palpation, a positive right lower extremity radicular testing, pain at the end of lumbosacral motion, and no evidence of muscle spasm.  

At the VA Compensation and Pension (C&P) exam performed less than a month before separation, the CI reported stiffness, limited movement, weakness, and difficulty straightening up after bending.  The pain was described as constant, aching, 6/10, and localized.  The pain was elicited by physical activity and relieved by medication (Motrin).  The physical examination showed tenderness to palpation of the paralumbar muscles, painful motion, a normal gait, no evidence of muscle spasm, and negative radicular testing bilaterally.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under the 5243 code (intervertebral disc disease).  The VA also assigned a 10% rating using the 5242 code (degenerative arthritis of the spine) based on the VA C&P examination, citing combined ROM of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees.  The Board agreed that a 10% rating, but no higher, was justified for a combined ROM (greater than 120 degrees, but not greater than 235 degrees) reported on the NARSUM and VA examinations.  There was no muscle spasm or guarding severe enough to result in abnormal gait or spinal contour, thus the next higher 20% rating was not justified on this basis.  There was no evidence of intervertebral disc syndrome resulting in incapacitating episodes requiring bed rest prescribed by a physician to warrant consideration of rating under the alternate VASRD formula based on incapacitating episodes due to intervertebral disc syndrome.  There was no evidence of an unfitting radiculopathy for consideration of a separate peripheral nerve 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 lumbar condition.

Neck Pain with Degenerative Disc Disease Condition.  According to STR and NARSUM, the CI’s neck and upper back pain condition began in September 2007 after a motorcycle accident.  An MRI study performed 13 November 2007 showed a small disc protrusion at the cervical 5-6 level.  There was no surgical indication, and conservative treatment did not result in improvement sufficient to allow unrestricted duty. The MEB forwarded “neck pain with degenerative disc disease” for PEB adjudication.  The NARSUM examination showed bilateral cervical paraspinous and trapezius muscle tenderness to palpation and painful motion without muscle spasm.  The VA C&P examination showed cervical tenderness to palpation and painful motion without evidence of radiating pain or muscle spasm.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under the 5243 code (intervertebral disc disease).  The VA also assigned a 10% rating using an analogous 5299-5243 code (intervertebral disc disease) based on the VA C&P examination 1 month before separation, citing combined ROM of the cervical spine greater than 170 degrees, but not greater than 335 degrees.  The Board agreed that a 10% rating, but no higher, was justified for combined ROM of the cervical spine greater than 170 degrees, but not greater than 335 degrees.  It was noted that muscle spasm was present on multiple chiropractic and physical therapy examinations, however it was not associated with  abnormal spinal contour to support the next higher rating of 20% (i.e. for muscle spasm or guarding severe enough to result in an abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis).  There was no evidence of intervertebral disc syndrome resulting in incapacitating episodes requiring bed rest prescribed by a physician to warrant consideration of rating under the alternate VASRD formula based on incapacitating episodes due to intervertebral disc syndrome.  There was no evidence of an unfitting radiculopathy for consideration of a separate peripheral nerve 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 cervical spine condition.

BOARD FINDINGS:  In the matter of the chronic low back pain with degenerative disc disease and radiculopathy condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the neck pain with degenerative disc disease 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 20140221, 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

Dear XXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2014-01106.

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