RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03605
BRANCH OF SERVICE:  Air Force	SEPARATION DATE: 20040529

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a Reserve E6, Ancillary Training Monitor, medically separated for “chronic low back pain,” with a disability rating of 20%.

CI CONTENTION:  “Please consider all conditions.”  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 - 20060417	VARD - 20070313	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5237	20%	Degenerative Disc Disease, Lumbar Spine	5243	10%	20040317	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI developed back pain from a fall in December 2003.  There were numerous STR clinical entries referable to the complaint from that time until separation.  There were some earlier complaints of radicular symptoms, but no positive findings on multiple neurological examinations; and, magnetic resonance imaging in July 2004 was interpreted as “mild facet arthropathy at L4-5 with no disc herniation or spinal stenosis.”  The STR entries closer to separation indicated moderate limitation (estimated as 25% reduction by one examiner) of range of motion (ROM).  One entry indicated an abnormal spinal contour with spasm, but no entries documented abnormal gait.  There was no STR documentation of incapacitating episodes.  Surgery was not recommended; conservative treatment did not result in improvement sufficient to allow unrestricted duty; and, the CI was referred for an MEB which in turn forwarded “low back pain” to the PEB.

The MEB NARSUM examination on 1 February 2006 (5 months before separation) documented “very limited in her [ROM] as well as ability to be able to lift ... causes her an extensive amount of problems and pain with her lower back.”  The physical examination recorded bilateral 5/5 strength in all extremities without other probative findings.  The MEB NARSUM addended physical therapy ROM measurements of flexion to 45 degrees (normal 90) and combined ROM of 125 degrees (normal 240).

The VA Compensation and Pension (C&P) examinations in evidence were temporally remote from separation and thus of limited probative value.  A C&P examination was conducted on 17 March 2004 from the preceding period of active duty, 26 months before the adjudicated date of separation.  It documented “low back pain all the time and cannot sit or stand too long without discomfort,” and recorded physical findings of normal gait, normal neurologic testing and normal measured ROM.  A C&P examination of 25 January 2008 (21 months after separation) documented constant severe pain and an antalgic gait with use of a cane, and recorded ROM measurements of flexion to 70 degrees and combined ROM of 170 degrees.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB’s 20% rating under code 5237 (lumbosacral strain) was consistent with VASRD §4.71a criteria for the service ROM and other ratable findings.  The VA’s earlier 10% rating under code 5243 (intervertebral disc syndrome) reflected the 2004 C&P evidence from above.  There was no ROM evidence supporting a rating higher than 20%, no evidence of additionally ratable peripheral nerve impairment, and no documentation of incapacitating episodes which would provide for a higher rating under that formula.  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 lumbar spine condition.

BOARD FINDINGS:  In the matter of the lumbar spine condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  There were no other conditions eligible for service rating 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 20140716, 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-2014-03605.

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