RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01178
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20080407

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E4, Security Forces Journeyman, medically separated for “low back pain due to degenerative disc disease” with a disability rating of 20%.  

CI CONTENTION: The applicant contends for his unfitting back condition and PTSD, which was not identified by either the MEB or PEB.  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 - 20071205	VARD - 20080821	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Low Back Pain Due to Degenerative Disc Disease S/P L4-5 Fusion, Decompression and Cage Placement 	5241	20%	Herniated Lumbar Disk at L4 through 5 with Subsequent Decompression and Fusion and Cage Placement	5243	20%	20080603	
			Radiculopathy, Left Lower Extremity Due to Disk Disease	8520	10%	20080603	
			Intervertebral Disk Degeneration	5243	NSC	20080603	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Low Back Pain.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent L4-5 fusion surgery in January 2007 for disc disease causing back pain and left lower extremity radiculopathy.  Following surgery, radiculopathy reportedly resolved but further treatment did not result in improvement of back pain sufficient to allow unrestricted duty.  The MEB forwarded “Back Pain” for PEB adjudication.

At a family practice clinic evaluation on 2 July 2007, 6 months after surgery and 9 months before separation, the CI complained of lower back pain that did not radiate into the legs.  He denied left leg weakness or numbness.  Physical examination noted a normal gait and painful thoracolumbar motion.  There was no evidence of peripheral neuropathy.  Goniometric range of motion (ROM) measurements performed by physical therapy (PT) on 17 July 2007 showed an average thoracolumbar flexion of 50 degrees (normal 90 degrees) and combined ROM of 155 degrees (normal 240 degrees).  The MEB NARSUM examination on 11 November 2007 (5 months prior to separation), noted complaints of pain with resolution of his lower extremity numbness.  The CI could not lift heavy objects, wear a rucksack or perform any running without pain.

At the VA Compensation and Pension (C&P) examination in June 2008, (2 months after separation), the CI reported back pain with weakness and stiffness.  Lower extremity weakness was denied, but he reported radiating pain down the left leg with tingling in the toes of both feet once or twice per week.  He could not run or participate in sports, but could sit without difficulty and walk about 8 or 10 blocks.  He also reported that bedrest was prescribed by a physician following his back surgery.  Physical examination showed an abnormal gait, “slightly slow, favors his back, hunched forward 15 degrees.”  Forward flexion was reported as “from 15 to 60 degrees,” but he could extend posteriorly to 15 degrees.  Combined ROM was 155 degrees.  Measurements were repeated 3 times without additional limitation noted.  Painful motion was present.  Lower extremity neurologic findings were normal except for mild decrease in sensation of all the toes of the left foot.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 20% rating under code 5241 (spinal fusion).  The VA also assigned a 20% rating using code 5243 (intervertebral disc syndrome) based on the VA C&P examination 2 months after separation, citing ROM criteria.  The VA also assigned a 10% rating using code 8520 (sciatic nerve, paralysis of, incomplete, mild) citing the mild decrease in sensation about the left foot.  The Board agreed that a 20% rating, but no higher, was justified for limitation of flexion (greater than 30 degrees but not greater than 60 degrees), reported on the Service PT and VA examinations.

The Board considered whether a higher rating (VASRD §4.7) was achieved by using the alternate rating formula based on incapacitating episodes due to intervertebral disc syndrome (IVDS).  Although the CI had intervertebral disc disease there were no incapacitating episodes requiring physician-prescribed bed rest to warrant consideration of rating under the alternate VASRD formula (for IVDS).  The Board finally considered if additional disability rating was justified for peripheral nerve impairment due to radiculopathy.  The CI had a pre-surgical history of left lower extremity radiculopathy which reportedly resolved post-operatively.  Although the VA examiner reported radiating pain and mild sensory deficit of the left toes, no examination showed muscle weakness, and any sensory changes did not affect his job.  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 is no evidence in this case that motor weakness existed to any degree that could be described as functionally impairing.  The Board therefore concluded 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 20140303, 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-2014-01178.

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