RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2014-02572
BRANCH OF SERVICE:  AIR FORCE	SEPARATION DATE:  20050330

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an Air National Guard E-6 (Air Surveillance Technician) medically separated for back conditions.  These conditions could not be adequately rehabilitated to meet the physical requirements of his Air Force Specialty.  He was issued a temporary P4 profile and referred for a Medical Evaluation Board (MEB).  Chronic low back pain (LBP) and degenerative disc disease (DDD) at L4-5-S1 with sciatic radiation and radiculopathy were forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123.  The Informal PEB (IPEB) adjudicated chronic LBP with radiculopathy as unfitting, rated 20% with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  The CI elaborated no specific contention in his application.

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 condition 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 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 IPEB – Dated 20050203	VA* - (Based on Service Treatment Records (STR))	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain with Radiculopathy	5243	20%	Herniated Disc L4-5…	5243	20%	STR	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 1	
RATING:  20%	RATING:  20%	
*Derived from VA Rating Decision (VARD) dated 20051027

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.

Low Back Condition.  Absent direct trauma, the CI first reported LBP in early 2002, alleging its cause as secondary to long driving commutes.  His painful symptoms were gradual and progressive and within a year, they worsened to include pain and numbness extending into his right leg and foot.  Radiographic tests revealed L4-L5 disc pathology affecting the L5 nerve root.  Specialty consultation determined that his condition was not amendable to surgical intervention.  Despite medications and activity restrictions, his pain remained throughout his career.  He was placed on profile in September 2004 and referred for a MEB.  The MEB narrative summary (NARSUM) examination dated 22 June 2004 (9 months prior to separation) referred to prior clinical notes for examination details.  The nearest clinical encounter to the June 2004 MEB NARSUM was an orthopedic evaluation dated 23 February 2004 (13 months prior to separation) where the CI endorsed LBP with radicular numbness and tingling extending down the right leg and foot.  The physical examination (PE) revealed lumbar spine tenderness without spasms.  Although thoracolumbar range-of-motion (ROM) was not numerically documented, flexion was noted to be decreased and described as “fingers 6 inches below knees.”  Distal motor, sensory, and strength parameters were intact.  The orthopedic diagnostic assessment was listed as “tingling right lower extremity secondary to sciatica versus herniated disc at the L4-L5 level.”

There was no VA C&P examination in the case file that correlated with the CI’s final date of separation in 2005.  A VARD (proximate to separation) indicated that the CI was awarded a 20% rating impairment based upon physical findings of limited motion and spasm.

The Board directed attention to its rating recommendation based on the above evidence.  Although the PEB and VA titled the unfitting back condition slightly differently, they both utilized code 5243 (Intervertebral disc syndrome) and rated the condition at 20%.  Board members first discussed the lack of clinical documentation that was evidenced during the disability evaluation process in this case and have agreed that the orthopedic evaluation (13 months prior separation) was the most relevant in determining an impairment rating based upon clinical evidence.  The non-numeric description of thoracolumbar flexion such as, “fingers 6 inches below knees” is often expressed and accepted in medical documentation.  The Board agreed that “fingers 6 inches below knees” easily equates to the rough guide of “fingers below knees to mid-shin” which further equates to approximately 60-80 degrees of flexion.  This degree of limited motion coupled with tenderness does not support a VASRD impairment rating greater than the PEB’s current 20%.  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’s adjudication for the LBP condition.

The Board additionally considered if the symptomatic lower extremity radiculopathy warranted additional service disability rating; but, members agreed that the requisite link of the neuropathic symptoms with functional impairment was not in evidence.  The CI’s subjective complaints were not objectively evidenced.  Any pain component of a radiculopathy is subsumed under the general spine rating as specified in §4.71a.  After due deliberation and considering all of the evidence the Board concluded 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 LBP 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 20140529, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD  20762

XXXXXXXXXXXXXXX
XXXXXXXXXXXXXXX
XXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2014-02572.

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,

				XXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings