ECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03760
BRANCH OF SERVICE:  Air Force	SEPARATION DATE:  20080623

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Fuels Journeyman, medically separated for “chronic low back pain,” with a disability rating of 20%.

CI CONTENTION:  The CI listed migraine/tension headaches; right shoulder tendinosis; chronic lumbar strain and left ankle tendinosis.  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 - 20080505	VARD – 20081231	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5243	20%	Chronic Lumbar Strain with Sacroiliac Pain 	5237	10%	20081008	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:

Low Back Pain.  According to service treatment records (STR) the CI suffered persistent low back following a strain injury in November 2005.  Serial magnetic resonance imaging studies were normal.  There were intermittent complaints of bilateral lower extremity radiation and sensory symptoms, but no complaints of subjective weakness.  There were multiple normal neurological examinations with 5/5 strength in evidence and surgery was not recommended.  The CI did not respond adequately to conservative treatment and was referred for a Medical Evaluation Board (MEB).  The MEB forwarded “chronic low back pain” to the PEB for adjudication.

Range of motion (ROM) measurements for the MEB were performed by physical therapy on 8 January 2008, 6 months before separation) and recorded flexion to 40 degrees (normal 90) with a combined ROM of 145 degrees (normal 240).  There were concurrent STR entries noting non-specifically decreased ROM, but none suggesting more severe limitation.  There was ample STR documentation of normal gait and spinal contour with no contrary entries.  There was no STR documentation of incapacitating episodes.

A VA Compensation and Pension (C&P) examination in October 2008, 4 months after separation, documented that the CI “complains of severe constant low back pain with radiating intermittent to the legs,” denying subjective weakness or sensory symptoms.  The examination recorded a normal gait and spinal contour, the absence of spasm or guarding, and detailed normal neurological findings (5/5 strength all groups).  The ROM measurements were flexion to 70 degrees and combined 220 degrees, specifying painful motion and no degradation with repetitions.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 20% rating coded 5243 (intervertebral disc syndrome), consistent with VASRD §4.71a criteria for the MEB physical therapy flexion of 40 degrees.  The VA assigned a 10% rating coded 5237 (lumbosacral strain), referencing the C&P examination 4 months before separation, citing flexion of 70 degrees.  The Board agreed that a 20% rating, but no higher, was justified for limitation of flexion (greater than 30 degrees but not greater than 60 degrees) based on the service ROM.  There was no documentation of incapacitating episodes which would provide for a higher rating under that formula.

Members agreed that there was no associated radiculopathy for separate peripheral nerve rating.  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 impairments such as weakness with a direct impact on fitness that were separately functionally impairing for duty.  The Board therefore concluded that additional disability rating was not justified on this basis.  After due deliberation, and in consideration of all 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 chronic low back pain condition.

BOARD FINDINGS:  In the matter of the chronic 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 20140811, 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-2014-03760.

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