RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01193
BRANCH OF SERVICE:  AIR FORCE	BOARD DATE:  20150203
SEPARATION DATE:  20080801

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Security Forces Journeyman) medically separated for a back condition.  The back condition could not be adequately rehabilitated to meet the physical requirements of her Air Force Specialty or satisfy physical fitness standards.  She was issued a 4T profile and referred for a Medical Evaluation Board (MEB).  The back condition, characterized as “low back pain,” was the only condition forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123.  The Informal PEB adjudicated “low back pain” as unfitting, rated 10%, with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION: The CI writes: “I was given a rating of 10% for my back problems but it was enough to remove me from duty.  Now I have been out for almost 6 yrs and I still have to take very strong medicine to control the chronic pain that I have everyday.  It prevents me from being able to do everyday things like clean, cook, walking up & down stairs.  Now I am told that at 27 years old I need a full hip replacement for my right hip due to arthritis.”

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e.(2).  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 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/Naval 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 IPEB – Dated 20080506	VA - (4 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Low Back Pain	5243	10%	Low Back Strain	5237	10%	20081229	
Other x 0 (Not in Scope)	Other x 0		
Combined:  10%	Combined:  10%	
Derived from VA Rating Decision (VARD) dated 200xxxxx (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Low Back Condition.  Absent direct trauma, the CI first reported low back pain (LBP) in early 2005, alleging its cause secondary to the wearing of load-bearing vests.  She denied any radicular component of pain.  Radiology tests were normal without evidence of trauma or arthritis.  Despite physical therapy, medications, activity restrictions, and local injections, her painful symptoms remained throughout her military career.  There were no periods of incapacitation.  She was placed on profile in September 2007 and referred for MEB.

At the MEB narrative summary examination on 4 February 2008, 6 months prior to separation, the CI reported pain and muscle spasms in her low back.  The physical examination (PE) revealed a normal gait/posture and full, but painful motion of the lumbosacral spine.  Additionally, there was low back muscle tenderness without spasm.  Distal motor and sensory parameters were intact.  The LBP diagnosis remained unchanged.

At the VA Compensation and Pension examination on 6 January 2009, 6 months after separation, the CI endorsed constant and localized LBP described as aching, sharp, sticking and cramping.  Her symptoms are worsened with physical activity and relieved with rest and medication.  She denied stiffness, numbness, or loss of bladder/bowel control from the back condition.  At the time of pain she can function with medication.  The [CI] reported “pain with lifting and bending” as her described functional impairments.  Her PE was normal excepting thoracolumbar tenderness and painful motion.  X-rays indicated normal spinal curvatures.

The goniometric range-of-motion (ROM) evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.

Thoracolumbar ROM
(Degrees)	PCC ~8 Mo. Pre-Sep
 	MEB ~6 Mo. Pre-Sep
 	VA C&P ~4 Mo. Post-Sep
	
Flexion (90 Normal)	FROM	FROM	FROM	
Extension (30)				
R Lat Flexion (30)		-		
L Lat Flexion (30)		-		
R Rotation (30)		-		
L Rotation (30)		-		
Combined (240)	240	-	240	
Comment	(+) painful motion	(+) tenderness;
(+) painful motion	(+) painful motion	
§4.71a Rating	10%	10%	10%	

The Board directed attention to its rating recommendation based on the above evidence.  Both the PEB and VA rated 10% under slightly different codes of 5243 (intervertebral disc syndrome) and 5237 (lumbosacral strain).  Board members agreed that sufficient evidence of painful motion was present to justify the 10% rating, as well as the presence of localized tenderness not resulting in abnormal gait or spinal contour IAW §4.71a.  Board members also considered application of §4.40 (functional loss) which states “a part which becomes painful on use must be regarded as seriously disabled” as seen on both prior to and after separation exams.  There were no available alternative or analogous coding options which were applicable and or advantageous to the CI’s current 10% rating.  Considering the totality of the evidence and mindful of VASRD §4.3 (reasonable doubt), members agreed that a disability rating of 10% for the LBP condition was appropriately recommended in this case.

BOARD FINDINGS:  IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB will not be considered by the Board to the extent they were inconsistent with the VASRD in effect at the time of the adjudication.  The Board did not surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD were exercised.  In the matter of the low 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.

RECOMMENDATION:  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, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

			
XXXXXXXXXXXXXXXXXXXX
President
DoD Physical Disability Board of Review

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD  20762

Dear XXXXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Title 10 U.S.C. § 1554a), PDBR Case Number PD-2014-01193.

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,

XXXXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings