RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX 	CASE:  PD-2014-03591
BRANCH OF SERVICE:  AIR FORCE 	SEPARATION DATE:  20030328

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-3 (Aircraft Technical Maintenance Apprentice) medically separated for a back condition.  The back condition could not be adequately rehabilitated to meet the physical requirements of his Air Force Specialty.  He was issued a P4 profile and referred for a Medical Evaluation Board (MEB).  “Chronic low back pain, mild to moderate HNP L4-5, non-surgical degenerative disk disease” was 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 secondary to degenerative disk disease” as unfitting, rated 10%, citing application of DOD and Veterans Affairs Schedule for Rating Disabilities (VASRD) guidelines.  The CI made no appeals and was medically separated.  

CI CONTENTION:  The applicant makes no specific contention in his application.  His complete submission is at Exhibit A.

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 20021230	VA* - (~4 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
LBP Secondary to DDD	5295	10%	Herniated Disc, L4/L5	5293	10%	20030620	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 12 	
RATING:  10%	COMBINED RATING:  30%	
*Derived from VA Rating Decision (VARD) dated 20030731 (most proximate to date of separation (DOS)).  

ANALYSIS SUMMARY:  The  VASRD coding and rating standards for the spine in effect at separation, which must be applied to the Board’s recommendation IAW DoDI 6040.44, differ significantly from the current §4.71a General Rating Formula for the Spine.  This rule set was in effect between 23 September 2002 and 25 September 2003.  
Low Back Pain (LBP) Secondary to Degenerative Disk Disease (DDD).  The record showed that the CI first presented with LBP on 2 April 2002 when he complained of a 7-day history of pain after lifting.  He was treated with medications and referred to physical therapy, but the pain persisted.  A magnetic resonance image performed on 5 June 2002 showed a right-sided herniated disc at L4-5.  He was then evaluated by neurosurgery on 14 August 2002 and found to have a normal neurological examination with full, painless range-of-motion (ROM).  Provocative testing for nerve root irritation was negative.  Surgery was not indicated.  The neurological examination, gait, and ROM were normal when seen 2 weeks later on 29 August 2002.  The CI declined injections when seen in the pain clinic on 25 September 2002.  He was seen in flight medicine on 30 September 2002 and again expressed a desire for separation.  He was tender over the L4-5 disc and mild spasm was noted.  The neurological examination remained normal and FROM (full ROM) was recorded.  Provocative testing for nerve root irritation remained negative.  The narrative summary was dated 30 September 2002.  The CI reported that his LBP started in December 2001 after pulling on a sock.  It was noted that he had previously reported that it began in March after lifting weights.  He reported that he was unable to do his job secondary to the LBP and that he could not lift more than 10 pounds.  Gait was noted to be normal.  

At the VA Compensation and Pension (C&P) examination performed on 20 June 2003, 4 months after separation, the CI reported that he had injured his back lifting a brake in February 2002 and was off work for a week.  This is not consistent with the contemporaneous records.  He then reinjured it in December 2002 and was given office work.  He reported constant pain and that he had been injured when struck by a police car in June 2003 (after separation).  On examination his gait was normal.  He had no tenderness and was able to flex his back 90 degrees before he had pain.  No assistive devices were in use.  A primary care visit on 1 July 2003 documented a normal neurological examination with tenderness of the paraspinal muscles.  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)	VA C&P ~4 Mo. Post-Sep	VA C&P ~12 Mo. Post-Sep	
Flexion (90 Normal)	90	90  (110)	
Combined (240)	-	240	
Comment	No Tenderness; normal gait		
§4.71a Rating	0%	0%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the back at 10% using the code 5295 (lumbosacral strain).  The VA also rated the back 10%, coded 5293 (intervertebral disc syndrome).  The Board observed that the week of  incapacitation reported by the CI to the VA was not supported by the records in evidence; regardless, this would does not support a higher rating.  No limitation in motion was recorded.  Tenderness was present, but not spasm.  The gait was normal.  Pain was noted with motion.  The Board found no route to a rating higher than the 10% adjudicated by the PEB and VA.  The Board noted that the neurological examinations were consistently normal.  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 for the back pain condition.  

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 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.  

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 20140617, 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

Dear XXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2014-03591.

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