RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02127
BRANCH OF SERVICE:  AIR FORCE	BOARD DATE:  20150122
SEPARATION DATE:  20051028

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Aerospace Maintenance Journeyman) medically separated for chronic low back pain (LBP).  The condition could not be adequately rehabilitated to meet the physical requirements of his Air Force Specialty or satisfy physical fitness standards.  He was issued a L4 profile and referred for a Medical Evaluation Board (MEB).  The “chronic low back pain” 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 low back pain” as unfitting, rated 10%, with application of the VA Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  “Please consider all conditions” [sic]

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 20050909	VA* - based on Service Treatment Records (STR)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5243	10%	Lower Back Condition	5010-5237	0%	No Show
STR	
Other x 0 (Not In Scope)	Other x 0 	
RATING:  10%	RATING:  #%	
*Derived from VA Rating Decision (VARD) dated 200612122 (most proximate to date of separation (DOS)).  

ANALYSIS SUMMARY:  The STR did not contain a VA Compensation & Pension (C&P) examination.  The pertinent historical medical information was obtained from a remote VARD summary.

Chronic Low Back Pain.  Absent direct trauma, the CI first reported LBP after lifting a heavy object in late 2003; and, painful symptoms persisted throughout the balance of his career.  Radiologic tests revealed degenerative disc disease of the lumbosacral spine.  He reported LBP with occasional radiation of pain into both legs; however, there was no consistent objective evidence of radiculopathy present on subsequent exams.  Surgery was not indicated and conservative treatment of medication, physical therapy, and multiple steroid injections did not provide long-term symptom relief.  There were no periods of VASRD defined incapacitation.  Secondary to the prolonged period of treatment, an MEB was initiated.  At the MEB narrative summary examination on 21 August 2005; 2 months prior to separation, the CI reported limited lifting ability due to LBP.  There was no comment in regards to current associated radicular symptoms.  The physical examination revealed a normal gait and full lumbosacral range-of-motion (ROM); however, tenderness and spasm was present in the spinal muscles.  The diagnosis remained chronic LBP.  There was no C&P examination in the file, but a remote VARD of 22 December 2006 revealed a 0% rating for a low back condition based upon a “no show” for a scheduled C&P examination.  

The goniometric 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)	PC ~4 Mo. Pre-Sep
(20050623) 	MEB ~2 Mo. Pre-Sep
(20050821) 	VA C&P	
Flexion (90 Normal)	‘Full ROM’	‘Full ROM’	‘No show’	
Extension (30)				
R Lat Flexion (30)				
L Lat Flexion (30)				
R Rotation (30)				
L Rotation (30)				
Combined (240)				
Comment	normal PE	(+) tenderness;
(+) spasm;
normal gait	-	
§4.71a Rating	0%	10%	-	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back condition at 10% utilizing code 5243 (Intervertebral disc syndrome).  Board members agreed that absent compensable ROM measurements, there did exist sufficient evidence of localized tenderness and spasm (not resulting in an abnormal gait or spinal contour) to support the PEB’s 10% rating IAW §4.71a.  The Board then considered application of §4.40, which allows for a higher rating if evidence of additional functional loss is present.  Member’s concluded however that there was no examination in evidence on which to base a conclusion that repetitive motion resulted in any additional disability.  The 5003 arthritic code was also considered, but absent incapacitating episodes, the maximum rating would render 10%; thus providing no additional benefit to the CI’s current rating by the PEB.  Therefore, Board members agreed that a rating higher than 10% was not justified.  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 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 20140426, 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-2014-02127.

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