RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXX					   	            CASE:  PD-2014-01258
BRANCH OF SERVICE: AIR FORCE	 Separation Date:  20090826

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Aircraft Armament Systems Journeyman) medically separated for a back condition.  The back condition could not be adequately rehabilitated to meet the physical requirements of his Air Force Specialty (AFS) or satisfy physical fitness standards.  He was issued a temporary U4 profile and referred for a Medical Evaluation Board (MEB).  Chronic low back pain (LBP) was forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123.  No other condition was submitted by the MEB.  The Informal PEB adjudicated “chronic LBP due to DDD at L5-S1” as unfitting, rated 20%, citing application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.  

CI CONTENTION:  His condition continues to worsen and negatively impact his daily activities.  His complete submission is at Exhibit A.

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 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:  

IPEB – Dated 20090508	VA* - (~7 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic LBP due to DDD at L5-SI	5243	20%	Low Back Strain with DDD	5237	20%	20100326	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 2	
RATING:  20%	RATING:  20%	
*Derived from VA Rating Decision (VARD) dated 20100513 (most proximate to date of separation (DOS)).  

ANALYSIS SUMMARY:  

Chronic LBP due to DDD at L5-SI Condition.  The CI developed a stabbing LBP in March 2007 after picking up a weapons door.  He went through physical therapy (PT) and had some improvement in his back until he reinjured his back in June 2007.  A lumbar spine MRI done in July 2007 showed a transitional vertebra, L5-S1 focal disc bulge/protrusion mildly compressing the thecal sac with a small annular tear.  In September 2007, the Neurosurgeon indicated that the CI was not a surgical candidate.  Despite extensive PT and medication, the LBP continued.  

The MEB Narrative Summary (NARSUM) exam approximately 9 months prior to separation documented that the CI had dull aching intermittent back pain.  Depending on the amount of physical activity at work, he would experience back stiffness the next day.  The examiner noted that the CI could not lift greater than 30 pounds due to DDD.  The MEB NARSUM physical exam findings are summarized in the chart below.  A PT exam range-of-motion (ROM) evaluation performed approximately 7 months prior to separation is also charted.    

The VA Compensation and Pension (C&P) exam approximately 7 months after separation documented that the CI reported dull constant LBP with decreased ROM, morning stiffness and an inability to stand more than 15 to 30 minutes.  He reported LBP flares of moderate to severe pain with jogging, jumping, heat or cold.  The VA C&P physical exam findings are summarized in the chart below.  

ROM evaluations 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)	MEB ~9 Mo. Pre-Sep	PT~7 Mo. Pre-Sep	VA C&P ~7 Mo. Post-Sep	
Flexion (90 Normal)	No ROMs	45	50	
Combined (240)		>120 and <235	185	
Comment	Pain on extension; tenderness; gait normal; motor/sensory/reflex normal	Inclinometer used; painful motion; motor/sensory exams normal	Reflexes/motor/sensory normal	
§4.71a Rating	10%	20%	20%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB coded the back condition 5243 (intervertebral disc syndrome), rated 20%.  The VA coded the back condition 5237 (lumbosacral strain), rated 20%.  The general rating formula for diseases and injuries of the spine considers the CI’s pain symptoms “with or without symptoms such as pain (whether or not it radiates), stiffness or aching in the area of the spine affected by residuals of injury or disease.”  Both the PT and C&P exams demonstrated forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; which meets the 20% rating criteria.  The Board agreed that there was no evidence that the CI had any periods of incapacitation (physician-prescribed bed rest) due to his back condition and there was insufficient evidence of intervertebral disc syndrome or neurologic deficits for alternative or additional ratings.  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 LBP condition.  

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 20140225 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

XXXXXXXXXXXX
XXXXXXXXXXXX
XXXXXXXXXXXX

Dear XXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2014-01258.

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,

								XXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings