RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX     					           CASE:  PD-2014-02620
BRANCH OF SERVICE:  AIR FORCE 	SEPARATION DATE:  20051011 

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Supply Management Journeyman) medically separated for a lumbar spine condition.  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 L4 profile and referred for a Medical Evaluation Board (MEB).  The condition “chronic low back pain” was forwarded as the sole submission to the Physical Evaluation Board (PEB) IAW AFI 48-123.  The Informal PEB adjudicated “chronic back pain secondary to mild spondylosis” as unfitting, rated 10%, referencing the Veterans Affairs Schedule for Rating Disabilities (VASRD).  Two additional conditions (“overweight” and “adjustment disorder, not otherwise specified [NOS]”) were determined to be Category III, conditions that are not separately unfitting and not compensable or ratable.  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 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 20050804	VA* (~2 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Back Pain ... Spondylosis	5242	10%	Lumbar Spondylosis	5242	20%	20051222	
			RLE Radiculopathy a/w Above	8520	0%	20051222	
Overweight	Category III	No VA Entry	
Adjustment Disorder NOS	Category III	No VA Entry	
Other x 0 (Not In Scope)	Other x 2	
RATING:  10%	RATING:  30%	
*Derived from VA Rating Decision (VARD) dated 20060425 (most proximate to date of separation [DOS]).  

ANALYSIS SUMMARY:    

Lumbar Spine Condition.  There are numerous entries in the service treatment record (STR) addressing a complaint of back pain dating to November 2003.  Initial X-rays were normal.  None of the entries identify radicular symptoms or positive neurologic findings, and many of them specify the absence of radicular symptoms and document normal strength and neurological exams.  Magnetic resonance imaging in November 2004 demonstrated mild degenerative spine changes and a “small” herniation at L4/5 without canal or nerve root impingement.  A follow-up orthopedic consultant documented normal neurologic findings and did not recommend surgery.  There are numerous STR entries documenting normal gait and grossly normal range-of-motion (ROM); and, no entries documenting abnormal gait or contour, or incapacitating episodes.  The only formal ROM measurements in the treatment records were provided by the CI’s primary care physician on 21 June 2005 (14 weeks prior to separation); and, recorded flexion to 45 degrees (normal 90 degrees) and combined ROM of 125 degrees (normal 240 degrees).  The narrative summary (NARSUM) was conducted 20 June 2005 (contemporary with above ROM exam), and dates the onset of back pain to a lifting injury in August 2003 (not corroborated in STR); but, does not characterize the severity or limitations.  The profile restricts lifting >15 pounds or standing >30 minutes, and permits light duties and running at her own pace.  The NARSUM physical exam documented paraspinal tenderness and normal neurological findings, without comment on gait or ROM.

A VA Compensation and Pension (C&P) examination was conducted 22 December 2005 (2 months after separation); and, documented constant back pain (no radiation or radicular symptoms) rated 3/10, limiting sit-ups and “many daily activities, strenuous,” and specifying the absence of incapacitation.  The VA physical exam documented a normal gait, tenderness, the absence of spasm, and normal strength and neurological findings.  VA measured ROM was 50 degrees flexion and 150 degrees combined.

The Board directed attention to its rating recommendation based on the above evidence.  Both the PEB and VA ROM evidence satisfy criteria for a 20% rating IAW the VASRD §4.71a spine formula.  The PEB’s 10% rating under code 5242 (degenerative arthritis of the spine) did not provide a rationale.  The VA’s 20% rating under the same code referenced the C&P flexion of 50 degrees.  There was no evidence of ratable peripheral nerve impairment or documentation of incapacitating episodes in this case which would provide for additional or higher rating.  After due deliberation, considering all of the evidence and conceding VASRD §4.3 (reasonable doubt), the Board recommends a 20% rating for the lumbar spine condition under code 5242.  

Adjustment disorder and overweight conditions are not compensable or ratable conditions and are not eligible 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 lumbar spine condition, the Board unanimously recommends a rating of 20%, coded 5242, IAW VASRD §4.71a.  In the matter of the contended adjustment disorder, the Board unanimously recommends no change from the PEB determination as not unfitting and not compensable IAW DoDI 1332.38 (E5.1.3.9.4).  There were no other conditions within the Board’s scope of review for consideration. 

RECOMMENDATION:  The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of her prior medical separation:  

CONDITION	VASRD CODE	RATING	
Lumbar Disc Disease	5242	20%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140602, 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-2014-02620.

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 not appropriate under the guidelines of the Veterans Affairs Schedule for Rating Disabilities.  Accordingly, the Board recommended modification of your assigned disability rating without re-characterization of your separation with severance pay. 

Sincerely,

			  XXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachments:
1.  Directive
2.  Record of Proceedings

cc:
SAF/MRBR