RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02496
BRANCH OF SERVICE:  AIR FORCE	BOARD DATE:  20150331
SEPARATION DATE:  20080805

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5 (Dental Craftsman) medically separated for chronic low back pain (LBP) due to degenerative disc disease (DDD).  The condition could not be adequately rehabilitated to meet the physical requirements of her Air Force Specialty or satisfy physical fitness standards.  She was issued a temporary P4 profile and referred for a Medical Evaluation Board (MEB).  The “lumbago,” “osteoarthritis,” and “chronic pain syndrome,” were 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 likely application of the Department of Defense Instruction (DoDI) 1332.39/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 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 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:

IPEB – Dated 20080606	VA* - (~7 Mos. Post-Separation) 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain due to DDD	5243	10%	Lumbosacral Spine Sprain Degenerative Joint Disease
(DJD) & Degenerative Disc Disease (DDD) (claimed also
as chronic pain syndrome & sacroiliitis)	5242-5243	10%	20090218	
Other x 0 (Not In Scope)	Other x 7 	
RATING:  10%	RATING:  40%	
*Derived from VA Rating Decision (VARD) dated 20090617 (most proximate to date of separation [DOS]).
ANALYSIS SUMMARY:

Chronic Low Back Pain due to DDD Condition:  Treatment records evidence that the CI developed lower back pain with radiation to the right buttock after a fall down the stairs in May 2005.  She was treated with chiropractic care, sacroiliac joint injections, and pain medications without relief.  A magnetic imaging study dated 18 October 2006 demonstrated mild degenerative arthritis of the lower thoracic and upper lumbar spine with mild disc bulging at the lumbar 4-5 and lumbosacral junction.  An orthopedic evaluation the same day noted some pain control with Motrin and Vicodin (narcotic) medication.  The physical examination demonstrated back pain with forward flexion, lateral bending, and rotation without muscle spasms.  There was also tenderness to palpation of the SI joints.  A pain management note dated 21 November 2007 documented that the CI’s pain did not respond to multiple medications including but not limited to narcotic and antidepressant medications.  The CI pain related sleep disturbance and “emotional sequelae.”  The examination demonstrated tenderness to palpation with moderate muscle spasms over the right para-lumbar region, right lower facet areas, and SI joint (right greater than left).  Tests for SI joint dysfunction were positive.  The examiner diagnosed chronic lower back pain and physical dependence on opiates.  A psychosocial evaluation was recommended.  At the psychosocial evaluation dated 4 December 2007, that examiner opined that there was no basis for the diagnosis of a mental disorder and that there was no suggestion of problematic use of prescribed medications.  A diagnosis of insomnia was rendered.  The CI underwent physical therapy, multiple facet joint injections, and pain medications.  The treatment notes evidence intermittent decreased in pain, but no pain resolution.

The narrative summary examination dated 6 March 2008 notes reports of increased pain with sitting, prolonged standing, and heavy lifting.  The CI reported that she missed work a total of 10 days over the past 3 years with 2-3 above baseline pain episodes requiring additional pain medication per month.  The back examination was significant for decreased back extension with tenderness to palpation over the lower right back.  The gait was normal and radiculopathy testing was negative.

At the VA Compensation and Pension examination performed 7 months after separation, the CI reported chronic 5-6/10 LBP radiating to the right buttock with DDD and sacroiliitis.  Episodes of increased pain associated with pain and fatigue occurred 2 times per month.  Medication management included Advil 600 milligrams twice a day and Ultram (Tramadol: opioid pain medication) for times a day as needed for pain.  The physical examination demonstrated a normal gait, nontender lumbosacral spine, and negative radiculopathy testing.  The range-of-motion was full with pain at the end of motion in all planes.  A diagnosis of lumbosacral strain with DDD and limited motion was rendered.

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB adjudicated the chronic lower back pain due to DDD as unfitting.  The PEB and VA rated the chronic LBP condition at 10%.  The Board considered whether the evidence supported a higher than 10% rating for the chronic LBP condition.  Considering the totality of the evidence and mindful of VASRD §4.3 (reasonable doubt), members agreed that a disability rating of 10% for the chronic lower back pain due to DDD condition was appropriately recommended in this case.  The Board noted that there was no evidence of a separately unfitting radiculopathy and concluded therefore, that this condition could not be recommended for additional disability rating.

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 lower back pain due to DDD 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 20140523, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

XXXXXXXXXXXXXXXXXXXX
President
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 (Section 1554, 10 USC), PDBR Case Number PD-2014-02496.

	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

cc:
SAF/MRBR