RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03038
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20071023

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Electric Power Production Journeyman, medically separated for “low back pain (LBP) due to degenerative disc disease (DDD),” with a disability rating of 10%.

CI CONTENTION:  The CI contends that there were additional medical conditions that were not considered by the PEB that the VA gave a rating for.  The CI’s complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited to those conditions determined by the Physical Evaluation Board (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 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 based on 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:  

SERVICE PEB - 20070815	VARD - 20080408	
Condition	Code	Rating	Condition	Code	Rating	Exam	
LBP due to DDD	5243	10%	DDD, S/P Laminectomy	5243	20%	20071228	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Low Back Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s LBP condition began in July 2006 without any specific injury or trauma.  Magnetic resonance imaging (MRI) studies, on 11 August 2006, showed a left paracentral disc protrusion at the L5-S1 level with impingement of the transiting left S1 nerve root.  Conservative treatment including medications, physical therapy, duty limitations, and injections were unsuccessful.  Therefore, surgery was performed on 28 December 2006.  Two months post-op, in a neurosurgery follow-up, on 1 March 2007, the CI was noted to have normal motor and sensory function as well as a normal gait.  The left heel reflex was absent.  The medical officer observed that the reflex did not always return after surgery and did not indicate a poor result.  In physical therapy, on 6 April 2007, the CI noted that his back was much better, but his pain persisted if he stood all day.  In another neurosurgery evaluation, on 1 May 2007, the neurological examination and gait remained unchanged (essentially normal) and the wound well healed.  The final neurosurgery encounter prior to separation was on 14 May 2007.  The CI reported infrequent pain down his left leg, but denied weakness.  He had returned to work and rarely took pain medications.  He was released to run at his own pace and distance.  Cross training was supported.  The neurological examination was normal other than the absent left heel reflex.  Although improved after surgery, the CI was unable to meet the physical requirements of the CI’s military specialty and was referred for an MEB.  The MEB forwarded “low back pain” for PEB adjudication.  No other conditions were forwarded by the MEB.  The MEB NARSUM examination was dated 20 June 2007, 4 months prior to separation, and referred to an evaluation on 22 May 2007.  The CI reported that he is unable to do sit-ups, unable to run without pain, unable to lift 25 pounds without significant pain to his back; however, he no longer has pain into his left lower extremity.  The NARSUM referred to a previous neurosurgical examination for physical findings (above).  The range of motion (ROM) examinations 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)	PT ~6 Mos. Pre-Sep	PT/MEB ~3 Mos. Pre-Sep	VA ~2 Mos. Post-Sep	
Flexion (90 Normal)	“Full at this time”	70	50	
Comments	Painful motion not documented	Painful motion not documented.  Noted as “full”	Painful motion	
§4.71a Rating	0%	10%	20%	

At the 28 December 2007 VA Compensation and Pension (C&P) evaluation, performed 2 months after separation, the CI reported constant dull ache pain with weekly flare-ups lasting 12-24 hours.  He stated that he does have some numbness down the back of the left leg into the lateral side of the foot and denied the use of any walking aides.  Physical examination showed a normal posture and gait.  The CI was non-tender to palpation in the lumbar spine, but a little tenderness on the left going down near the SI joint and no palpable spasms.  The CI complained of pain on motion during range of motion testing of forward flexion and left and right lateral rotation.  There was slight loss of motion after three repetitions for forward flexion.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the LBP condition 10% coded 5243 (intervertebral disc syndrome), citing DoD and VASRD guidelines.  The VA rated the low back pain condition at 20%, as DDD, status post laminectomy with S1 neuropathy, based on the VA C&P examination 2 months after separation, citing limitation of forward flexion.  The Board agreed a 10% rating, but no higher, was justified for limitation of flexion (greater than 60 degrees but not greater than 85 degrees) and combined ROM (greater than 120 degrees but not greater than 235 degrees) reported on the NARSUM examination.  There was no muscle spasm or guarding severe enough to result in an abnormal gait or spinal contour; thus, the next higher 20% rating was not justified on this basis.  In assigning probative value to these somewhat conflicting examinations, the Board noted that the MEB used physical therapy measurements which were consistent with the diagnostic and clinical pathology in evidence and that the measurements in physical therapy were noted as “full” on several occasions; therefore, based on all evidence and the associated conclusions just elaborated, Board consensus was that preponderant probative value should be assigned to the MEB ROM examination.  The Board also considered if additional disability rating was justified for peripheral nerve impairment due to radiculopathy.  While the CI may have experienced radiating pain from the back condition, this is subsumed under the general spine rating criteria, which specifically states “with or without symptoms such as pain (whether or not it radiates).”  There was no objective evidence of a radiculopathy with functional impairment (such as weakness) that directly impacted fitness for duty.  The absent left heel reflex has no occupational significance and does not support a separate “unfitting” adjudication.  The Board therefore concluded that an additional disability rating was not justified on this basis.  After due deliberation, and 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 LBP condition.

BOARD FINDINGS:  In the matter of the low 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.  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 20130611, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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

Dear XXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2014-03038.

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