RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXX	CASE:  PD-2014-02448
BRANCH OF SERVICE:  AIR FORCE	BOARD DATE:  20140729
SEPARATION DATE:  20060510

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SSgt/E-5 (3P071/Security Forces) medically separated for chronic low back pain (LBP) with degenerative disc disease (DDD).  The back condition could not be adequately rehabilitated to meet the physical requirements of his Air Force Specialty or satisfy physical fitness standards.  He was issued an L4 profile and referred for a Medical Evaluation Board (MEB).  The back condition, characterized as “chronic low back pain w/degenerative disc disease,” was forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated “chronic low back pain with degenerative disc disease” as unfitting, rated 10%, referencing application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  “Please consider all conditions.”

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 LBP with DDD is addressed below; no additional conditions are within the DoDI 6040.44 defined purview of the Board.  Any conditions or contention not requested in this application, or otherwise outside the Board’s defined scope of review, remain eligible for future consideration by the Board for Correction of Military Records.  

RATING COMPARISON:

Service IPEB – Dated 20060327	VA - (3 Years Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Low Back Pain with Degenerative Disc Disease	5243	10%	Intervertebral Disc Syndrome	5243	10%	20090416	
Other x 0 (Not is Scope)	Other x 0		
Rating:  10%	Rating:  10%	
Derived from VA Rating Decision (VARD) dated 20090518 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:  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 VASRD standards based on ratable severity at the time of separation.

Low Back Pain Condition.  The narrative summary (NARSUM) notes the CI to develop LBP after lifting and running with a backpack in 2000.  Routine X-rays of the lower back revealed a “probable” area of spondylosis in the low back area.  A magnetic resonance imaging of the back obtained in September 2005, revealed mild degenerative joint disease, a small disc without nerve compression and an annular tear of the cartilage in the low back area.  The CI was examined by neurosurgery and was not considered a candidate for corrective surgery.  At the MEB NARSUM evaluation on 21 February 2006, 3 months prior to separation, the CI reported no “neuropathic symptoms.”  Findings on the physical exam are recorded in the chart below.  At the VA Compensation and Pension exam performed 3 years after separation, the CI reported back pain radiating down his left leg but denied numbness and episodes of incapacitation due to the condition.  Findings on physical examination are recorded in the chart below.

The goniometric range-of-motion (ROM) evaluations and other data which the Board weighed in its rating recommendation are summarized in this chart:

Thoracolumbar ROM
(Degrees)	MEB ~ 3 Mo. Pre-Sep
(20060221) 	VA C&P ~ 3 Years Post-Sep
(20090416) 	
Flexion (90 Normal)	75	90	
Extension (30)	Full	15	
R Lat Flexion (30)	Full	25	
L Lat Flexion (30)	Full	25	
R Rotation (30)	Full	25	
L Rotation (30)	Full	25	
Combined (240)	240	205	
Comment	Normal gait and transfer; mild spasm; normal motor, reflexes and sensory exams 	Radiating pain left leg on motion; no muscle spasm/tenderness; no motor weakness; no DeLuca; slt decreases sensation left upper and mid-thigh 	

The Board directs attention to its rating recommendation based on the above evidence.  The PEB and VA both rated the back condition 10%, code 5243, (intervertebral disc syndrome) citing reduced ROM flexion of 75 degrees and combined ROM of 205 degrees respectively.  Under this code a rating of 10% requires forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees or combined ROM of 120-235 degrees.  The next higher rating 20%, requires flexion of the lumbosacral spine greater than 30 degrees but not greater than 60 degrees or combined ROM of not greater than 120 degrees.  The Board unanimously agreed the record in evidence supported a 10% rating under this code IAW §4.40.  The Board considered a rating IAW §4.124 (neuralgia, peripheral nerve).  The Board agreed there was no ratable peripheral nerve impairment in this case since the preponderance of evidence in record showed that no motor weakness was present, that sensory symptoms had no functional implication and radiation of leg pain was subsumed under code 5243 IAW §4.71a.  The Board considered a rating under code 5243 (incapacitating episodes/intervertebral disc syndrome).  An incapacitating episode is defined as a period of acute signs and symptoms due to intervertebral disc syndrome that requires bed rest prescribed and treated by a physician.  Under this code a 10% rating requires incapacitating episodes having a total duration of at least a week but less than 2 weeks during the past 12 months.  A higher rating of 20% requires incapacitating episodes of at least 2 weeks, but less than 4 weeks, during the past 12 months.  The record documents incapacitation with placement of CI on quarters for a total of 7 days in the 12-month period prior to separation.  The Board concluded that no rating higher than 10% could be recommended under this code and agreed that this rating was not additive to the rating for reduced ROM IAW §4.71a.  The Board found no other appropriate codes for consideration.  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 back 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.  In the matter of the back pain 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 20140519, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

		

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-2014-02448.

	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