RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2014-03771
BRANCH OF SERVICE:  AIR FORCE	BOARD DATE:  20150619
SEPARATION DATE:  20070301

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5 (F-15 Aircraft Maintenance) medically separated for a back condition.  The back could not be adequately rehabilitated to meet the physical requirements of his Air Force Specialty.  He was issued a temporary U4/L4 profile and referred for a Medical Evaluation Board (MEB).  “Chronic low back pain” forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123.  No other condition was submitted by the MEB.  The Informal PEB adjudicated “chronic thoracic back pain due to degenerative disc disease (DDD)” as unfitting, rated 10%, with citing application of Department of Defense and Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  “Please consider all conditions.”

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 20070109	VA* - (~24 mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Back Pain	5243	10%	Thoracic Strain with Early Degenerative Changes	5242	10%	20090227	
Other MEB/PEB Conditions x 0 (Not in Scope)	Other x 3	
RATING: 10%	RATING: 10%	
*Derived from VA Rating Decision (VARD) dated 20090319 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Back pain.  In Spring 2003, this CI started having mid-back pain.  There was no specific trauma or injury associated with the onset of pain.  Radiologic imaging studies were unremarkable.  It was determined that he was not a surgical candidate.  He was treated with physical therapy, facet injections, and other measures.  In spite of all treatment efforts, the back pain persisted and an MEB was initiated.  The MEB narrative summary was dated 15 August 2006.  The CI reported that his pain was worse with forward flexion or hyperextension.  The pain was also aggravated by lifting heavy objects.  He denied any radiculopathy.  On physical examination (PE), he was in no acute distress and his gait was normal.  The back was non-tender to palpation.  There was no muscle spasm, and straight leg raise (SLR) was negative.  Neurological exam was normal.  In December 2006, his thoracolumbar range-of-motion (ROM) was assessed.  The back ROM was recorded as percentages, and those values are summarized in the chart below.

The CI was medically separated from service on 1 March 2007.  Two years later, on 27 February 2009, he had a VA Compensation and Pension exam.  He reported that he continued to have mid-thoracic back pain on a daily basis.  He was working as a sales representative, and was not using any medication at that time.  He denied any incapacitating flare-ups that caused him to miss work.  On PE, he was in no acute distress and his gait was normal.  There was some tenderness of the lower thoracic spine.  SLR was negative, and neurological exam was normal.  Back ROM was measured, and those measurements are summarized in the chart below.

Thoracolumbar ROM
(Degrees)	MEB ~ 2½ mos. Pre-Sep	VA C&P ~ 24 mos. Post-Sep	
Flexion (90 Normal)	approx. 75% (~67.5)	90	
Extension (30)	approx. 25% (~7.5)	10	
R Lat Flexion (30)	approx. 75% (~22.5)	15	
L Lat Flexion (30)	approx. 75% (~22.5)	20	
R Rotation (30)	approx. 75% (~22.5)	20	
L Rotation (30)	approx. 75% (~22.5)	20	
Combined (240)	(unable to calculate)	175	
§4.71a Rating	10%	10%	

The Board directed attention to its rating recommendation based on the above evidence.  The Board noted that the December 2006 ROM assessment was just 11 weeks prior to the DOS.  At that exam, thoracolumbar forward flexion was 75% of normal.  This means that his flexion was greater than 60 degrees, but not greater than 85 degrees.  IAW the VASRD §4.71a General Rating Formula for Diseases and Injuries of the Spine, a 10% disability rating is warranted for forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees.

Therefore, the Board determined that a separation disability rating of 10% was appropriate.  The Board tried to find a path to a higher rating.  There was not sufficient evidence of muscle spasm or guarding severe enough to cause abnormal gait or abnormal spinal contour.  The Board considered using other diagnostic codes which could be applied to the CI’s condition.  The other VASRD codes that were considered did not result in a higher rating, since the record did not show sufficient evidence of a seriously disabling back condition or spinal abnormality which would justify a higher rating.

The Board also considered the matter of radiculopathy.  After review of all the information in the record, there was insufficient evidence of a clinically significant radiculopathy that interfered with performance of military duties.  Therefore, the Board concluded that there was no unfitting radiculopathy present at the time of separation.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board found insufficient cause to recommend a change in the PEB adjudication of 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 chronic 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.

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, date-stamped 20140820, 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

XXXXXXXXXXXXXXX
XXXXXXXXXXXXXXX
XXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2014-03771.

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,

XXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings

cc:
SAF/MRBR