RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXX	CASE:  PD-2014-01500
BRANCH OF SERVICE:  AIR FORCE	BOARD DATE:  20140917
SEPARATION DATE:  20050711

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SSgt/E-5 (8R000/Recruiter & 2T351/Vehicle and Vehicular Equipment Maintenance) medically separated for a back condition.  He was issued a permanent L4 profile and referred for a Medical Evaluation Board (MEB).  The back condition, characterized as “low back pain”, was forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123.  No other conditions were submitted by the MEB.  The Informal PEB (IPEB) adjudicated “chronic back pain secondary to degenerative disc disease T12-L1 associated with myofascial pain syndrome” as unfitting, rated at 20%, with application of Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  “I have more pain in my back, I have had panic attacks while under stress.  Loss of flexibility in bending and reaching, sitting, standing and so on.(continued) I’m having pain, loss of motion in my neck, and right shoulder and right knee.  All of which have led me to a less fulfilled life.  These combined with my other injuries interfere with everyday life, not to mention a career or having even gainful employed.” 

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 those conditions identified, but not determined to be unfitting by the PEB when specifically requested by the CI.  The rating for the unfitting back condition with myofascial pain is addressed below.  The neck, right shoulder, left shoulder, left hip, depression, knee and panic attacks, as per the contentions were not identified by the MEB or PEB therefore are not within the DoDI 6040.44 defined purview of the Board.  These and any other condition or contention not requested in this application, remain eligible for future consideration by the Board for Correction of Military Records.

The Board acknowledges the CI’s information regarding the significant impairment with which his service-connected conditions continue to burden him.  IAW DoDI 6040.44, the Board’s authority is limited to making recommendations on correcting disability determinations.  The Board’s role is thus confined to the review of medical records and all evidence at hand to assess the fairness of PEB rating determinations, compared to Veterans Affairs Schedule for Rating Disabilities (VASRD) standards, based on ratable severity at the time of separation.

RATING COMPARISON:

Service IPEB – Dated 20050523	VA* - (11.1 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Back Pain…	5243	20%	DDD, Thoracolumbar Spine 	5243	20%	20060608	
Other x 0 (Not in Scope)	Other x 8 (Not in Scope)	20060616	
Combined:  20%	Combined:  40%	
*Derived from VA Rating Decision (VARD) dated 2000726 (most proximate to date of separation)

ANALYSIS SUMMARY:

Chronic Back Pain Condition.  The CI developed low back pain after a fall during training in 1999.  Despite multi-modality physical therapy, pain medication and injections the CI continued to experience activity-limiting low back pain that sometimes radiated to his thighs.  Magnetic resonance imaging (MRI) revealed a small right-sided disc protrusion at L1-2 and circumferential disc bulging at T12-L1.  Evaluation by a neurosurgeon determined that there was no clear benefit to operative intervention and the CI opted against surgery.  During a pain management appointment dated 3 February 2005 (5 months prior to separation), the specialist noted the chief complaint of low back pain and did not report any other areas of pain.  The physical exam indicated evidence only of lumbar spine pain.  The diagnosis assessment was lumbar spondylosis and myofascial pain syndrome.  

During the narrative summary (NARSUM) exam dated 16 April 2005 (3 months prior to separation), the CI reported constant 3/10 severity pain in the central low back area.  Sitting or driving for more than 15 minutes caused the severity to increase to 8/10 to 9/10.  He was unable to jog or bike without significant pain and could not carry his recruiting supplies.  Examination showed mild paraspinal lumbar muscle tenderness.  Muscle spasm, gait and spinal contour were not mentioned.  The examiner referred to the pain management physician’s diagnosis of myofascial pain as a component of the lumbar spondylosis.

At the VA Compensation and Pension (C&P) exam dated 8 June 2006 (11 months after separation), the CI reported difficulty finding a job because of his back condition.  Pain was constant and 3/10 to 4/10 in severity.  Walking more than a couple of blocks or prolonged standing exacerbated the pain of 4/10 to 5/10.  He took no medication for his back pain condition.  Physical exam showed an increased lordotic curve, but comments of muscle spasm were omitted.  Gait was normal and there was no use of an assistive device or back brace.  Repetitive motion did not result in additional limitation.  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)	MEB PT 3 Mos. Pre-Sep	VA C&P 11 Mos. Post-Sep	
Flexion (90 Normal)	45	60	
Combined (240)	150	180	
Comment	+Painful motion	+Painful motion	
§4.71a Rating	20%	20%	

The Board directs attention to its rating recommendation based on the above evidence.  The PEB assigned a 20% rating under the 5243 code (intervertebral disc syndrome) and properly subsumed myofascial pain syndrome in the adjudication.  The VA also rated the condition at 20% using the same code.  Based on the documented limitation of motion and IAW VASRD §4.71a criteria, at 20% rating is warranted in this case (forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees).  The next higher 40% rating requires forward flexion of the thoracolumbar spine of 30 degrees or less, or favorable ankylosis of the entire thoracolumbar spine, neither of which was present.  The Board also could not find evidence to support a higher rating under the formula for rating intervertebral disc disease based on incapacitating episodes.  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 chronic back pain 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 chronic back pain secondary to 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.

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 20131217, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

				
XXXXXXXXXXXXXX
President
DoD Physical Disability Board of Review

SAF/MRB

Dear XXXXXXXXXXXXXX:

	Reference your application submitted under the provisions of DoDI 6040.44 (Title 10 U.S.C. § 1554a), PDBR Case Number PD-2014-01500

	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,

XXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings