RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01635
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20090111

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

CI CONTENTION:  The CI’s makes no specific contentions.  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 - 20081124	VARD - 20090210	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Low Back Pain due to Degenerative Disc Disease	5243	20%	Degenerative Disc Disease of L5-S 1 (claimed as Low Back
Condition)	5242	20%	20081003
and
20090104	
			Left Leg Radiculopathy (also claimed as Nerve Damage)	8621	NSC	20081003
and
20090104	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:  

Low Back Pain Due to Degenerative Disc Disease.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s low back pain condition began in 2005.  Magnetic resonance imaging (MRI) studies November 2006 and July 2008 showed degenerative disc changes at L5-Sl disk with a central bulge, and minimal root compression.  A neurosurgery evaluation dated 2 February 2007 noted improved lower back pain with recommendation for a corset.  In April 2007, neurosurgery determined that no surgical intervention was required.  At the time of a neurosurgery clinic appointment on 27 November 2007, the examiner recorded a back pain and intermittent leg pain. The CI denied radicular pain.  The examiner noted intact motor strength and sensation with symmetrical reflexes.  During a family practice clinic appointment on 17 June 2008, the CI reported lower back pain which radiated into her left leg.  She also reported bilateral leg, left greater than right, weakness and numbness.  On examination there was mild pain with lumbosacral flexion.  Straight leg testing for radiculopathy was positive on the left.  A contralateral straight leg test was negative for radiculopathy.  There was no tenderness to palpitation or muscle spasms.  Lumbosacral spine motion, motor strength, reflexes, and gait (with a post-operative boot) were normal.  Despite treatment, the back condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for an MEB.  The MEB forwarded “low back pain” for PEB adjudication.  At the time of the physical therapy clinic appointment on 18 July 2008, and reflected in the NARSUM dated the same the range-of-motion (ROM) was forward flexion of 60 degrees (90 degrees normal) and a combined ROM of greater than 125 degrees and not greater than 185 degrees (240 degrees normal).  The MEB NARSUM examination on 18 July 2008 (4 months prior to separation) noted complaints of lower back pain which she described as “aching, constant, numbness, pressure, shock-like, shooting, throbbing, tingling and pinching”.  Physical examination showed full ROM with pain on flexion.  Gait and motor strength were normal.  Reflexes were normal in the lower extremities with the exception of the right ankle which was limited by a post-operation boot due to a recent right foot surgery.  Straight leg testing for radiculopathy was positive on the left.  At the VA Compensation and Pension (C&P) examination on 3 October 2008, performed 3 months before separation, the CI reported daily 6/10 lower back pain with radiating pain down the left posterior leg to the foot and constant numbness in her lower back and buttocks.  The back pain was aggravated with prolonged sitting, bending, standing as well as lifting.  She reported no loss of bowel or bladder control; however, coughing aggravated her back pain and caused mild urinary incontinence.  Additionally, she reported had not missed work for any of her claimed conditions except her back.  Physical examination showed a normal spine alignment and gait with normal reflexes and sensation.  There was tenderness noted throughout the lumbar spine.  Straight leg raise testing was negative for radiculopathy.  The ROM pre-exercise was forward flexion of 40 degrees (90 degrees) normal and a combined ROM of 140 degrees (240 degrees normal); post-exercise the forward flexion was 25 degrees with a combined ROM of 110 degrees.  However, the examiner stated “there was no evidence of pain, weakness, incoordination, fatigability or flare-ups.”  During a neurosurgery clinic appointment on 29 October 2008 the CI reported back pain with constant pain down her left leg with some numbness.  The physical examination showed a normal gait with motor and sensory functions intact.  Neurological testing indicated knee jerks and ankle jerks 1 plus.  Straight leg testing for radiculopathy was negative at 75 degrees bilaterally.  The provider indicated additional treatment options be considered and recommend a plasma disc decompression.  

At the VA Compensation and Pension (C&P) examination on 14 January 2009, performed 3 days after separation, the CI reported continued 5-6/10 low back pain aggravated by coughing, prolonged sitting, walking, bending and lifting with flare-ups which were reported as “at this time that occur one time every two weeks or even one time every three months”.  She stated “that she does go to the hospital for these flare-ups.”  She reported the flare-ups lasted two or three days during which she had numbness and pain to her left posterior leg and the left leg with numbness constant rather than intermittent.  Additionally, she reported left leg weakness with no loss of bowel bladder control, but some mild bladder incontinence with coughing, sneezing or laughing.  Physical examination showed a normal spine alignment and gait.  There was tenderness to palpitation of the lower lumbar spine and mild tenderness to the bilateral paraspinal muscles.  Right lower extremity strength was normal 5/5; the left was 4/5.  Light touch sensation was intact in both feet, but reduced in the left calf compared to the right. Straight leg testing for radiculopathy was positive in the supine position at approximately 10 degrees and negative in the upright position at 90 degrees.  The ROM forward flexion both per-exercise and post-exercise was 20 degrees (90 degrees normal) the combined ROM pre-exercise was 110 degrees and 130 degrees post-exercise (240 degrees normal).  There was evidence of painful motion, but no evidence of weakness, incoordination, fatigability or flare-ups.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back pain due to degenerative disc disease condition 20% coded 5243 (intervertebral disc syndrome), citing limitation of forward flexion.  The VA rated the low back pain condition 20% coded 5242 (degenerative arthritis of the spine), based on the VA C&P examinations 3 months before separation and 3 days after separation, citing limitation of forward flexion.  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 (physical therapy, NARSUM and VA, examinations.  Radiographic studies supported some level of radicular nerve irritation or involvement, but physical examinations, (physical therapy, MEB NARSUM, and VA C&P) proximate to separation revealed no objective findings of radiculopathy that would impact duty performance.  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 low back pain due to degenerative disc disease condition.  

BOARD FINDINGS:  In the matter of the low back pain due 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.  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 20140226, w/atchs
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-2014-01635.

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