RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03454
BRANCH OF SERVICE:  AIR FORCE	BOARD DATE:  20151026

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4, Dental Assistant, medically separated for a low back pain (LBP) condition, rated at 20%.  

CI CONTENTION:  “Back has gotten worse and the pain medication used to treat the pain has caused heart condition and contributed to mental issues.  Also suffering from severe migraines, believed to be a side effect.  Pain meds and heart meds used daily have special accommodations for work as well.” The applicant’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 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:  

SERVICE PEB – 20050912	VARD - 20060829	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain with Radiculopathy	5237	20%	Degenerative Disc Disease, L5-S1 with Radiculopathy	5243	20%	20060829	
			Peripheral Neuropathy, RLE	8520	10%	20060829	
			Peripheral Neuropathy, LLE	8520	10%	20060829	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain.  The service treatment record (STR) reflected that the CI injured her low back after being caught in-between a wind-blown door and its frame in November 2002.  She received long term conservative treatment consisting mainly of medication and physical therapy (PT).  Despite treatment, her painful symptoms persisted with intermittent pain extension into her left leg and foot.  Magnetic resonance image (MRI) performed on 5 May 2005 revealed a lumbosacral disc protrusion with encroachment upon the spinal nerve.  She declined epidural steroids and or surgical intervention and chose pain management treatment for the remainder of her Service career.  She received multiple physical restrictions and was referred to a Medical Evaluation Board (MEB).  At the MEB narrative summary (NARSUM) examination (04 August 2005; 3 months prior to separation), the CI’s chief complaint was “chronic lower back pain with left lower leg weakness.”  Her physical examination (PE) revealed a left-sided ambulatory limp.  There was decreased tenderness and decreased range of motion (ROM) of the lumbosacral spine.  Bilateral supine strait leg raises were identified as positive noting 45 degrees on the right and 30 degrees on the left, thus indicating left-sided neural involvement of spinal origin.  There was no comment with regard to the presence of painful motion.  

At the VA Compensation and Pension (C&P) examination (29 August 2006; 10 months post-separation), the CI reported stiffness with flexion of back and pain radiating to feet.  The VA provider stated the following which appeared somewhat inconsistent with a pain condition… “The spine condition does not cause any pain symptom.”  Additionally, “There is no functional impairment resulting from the [spine] condition.”  Her PE revealed a normal gait although she utilized a cane for ambulation… “because of back pain”.  Thoracolumbar ROM was painful, but normal.  Tenderness was present.  There was no evidence of muscle spasms, no radiating pain upon movement or abnormal neurologic tests with regard to strait leg raising.  There was decreased pin-prick sensation in both lower extremities.  Repeat lumbar spinal x-rays remained normal.  The CI’s final diagnosis was sacroiliac joint dysfunction.  The goniometric ROM evaluations 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)	MEB (PT)~4 Mos. Pre-Sep
(20050705) 	VA C&P~10 Mos. Post-Sep
(20060829) 	
Flexion (90 Normal)	40	90	
Extension (30)	0	30	
R Lat Flexion (30)	10	30	
L Lat Flexion (30)	15	30	
R Rotation (30)	45	30	
L Rotation (30)	20	30	
Combined (240)	130	240	
Comment	altered gait (limp); tenderness	painful motion; tenderness; 
‘decreased’ sensation in LE	
§4.71a Rating	20%	10%	

The Board directed its attention to its rating recommendation based on the above evidence.  Both the PEB and VA rated the back condition under similar VASRD primary codes of 5237 (lumbosacral strain) and 5243 (intervertebral disc syndrome) at 20% citing a radiculopathy by the PEB and incapacitating episodes by the VA.  Additionally, the VA rated 10% each lower extremity for a peripheral neuropathy condition.   

Board members first considered examination probative value in this case between the above charted PT evaluation and the VA examination and agreed that the MEB/PT exam be apportioned near exclusive probative value due to the nearest timeframe from separation.  Members agreed that the documented decreased ROM clearly supports the PEB’s 20% impairment rating.  Although the STR documented various times that the CI was placed in quarters (indicative of incapacitating episodes), the VASRD minimum criteria of 1 week in the preceding year was not achieved and therefore, no additional rating can be applied for such a residual.  Members then considered and deliberated whether a separately ratable radiculopathy existed with functional impairment linked to fitness near the time of service separation.  Members concluded that the most probative value examination in this case did not reveal such physical anomalies and therefore not meeting criteria to conclude a separately unfitting neurologic condition.  Any pain component of a radiculopathy is subsumed under the general spine rating as specified in §4.71a.  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 of the low back condition.

BOARD FINDINGS:  In the matter of the low back 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 20140708, 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-2014-03454.

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