RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03852
BRANCH OF SERVICE:  Air Force	SEPARATION DATE:  20071207

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an E5 Supply Technician, medically separated for “chronic low back pain with radiculopathy, status-post microdiskectomy of L4-5” with a disability rating of 10%.

CI CONTENTION:  Feels he was not treated fairly and forced to participate in some physical training against his physician’s advice.  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 upon a 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 – 20070726	VARD - 20080507	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain with Radiculopathy, status-post Microdiskectomy of L4-5	5243	10%	Lumbar Degenerative Disc Disease Status Post microdiskectomy	5243	10%	20080326	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s chronic low back pain condition began in August 2001 after heavy lifting.  His pain continued to worsen with physical movement.  The CI used muscle relaxants and anti-inflammatory medications.  An MRI in September 2001 revealed a herniated disc at L4-L5.  In December 2001, a neurosurgeon recommended surgery.  In January 2002, the CI underwent a lumbar laminectomy with a micro lumbar diskectomy at L4-L5 procedure.  Some improvements were noted with physical therapy (PT).  Five lumbar spine views noted degenerative disc disease (DDD) stable since March 2003.  At that time, it was noted there was no fracture or subluxation.  In November 2006, the CI complained of chronic back pain, which prevented him from performing his physical fitness test.  In December 2006, an MRI revealed an L4-L5 loss of disc height and status post laminectomy on the left.  The CI was again seen by neurosurgery in February 2007 for increasing back pain and worsening with standing and sitting.  Surgical intervention and other treatment modalities did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “lumbago,” “herniated nucleus pulposus,” and “lumbar degenerative disk disease” for PEB adjudication.

At the time of the neurosurgery appointment on 21 February 2007, the examiner reported he had operated on the CI in 2002 for a disc herniation at L4-5 on the left side.  He documented that the CI had “made an uneventful recovery and returned to full activities in the Air Force.”  However, the examiner further noted that the CI had increasing back pain over the past several years exacerbated by prolonged standing, sitting and accompanied with numbness and tingling in his legs.  The physical examination revealed negative straight leg raise tests (assess for herniated disc causing sciatic nerve root [L5-S1] radiculopathy) with no motor, sensory or deep tendon reflex abnormalities.  The CI’s range of motion (ROM) restrictions were mild in all directions.  The examiner recounted the findings of an MRI which showed postoperative changes, but no evidence of recurrent disc herniation.  The 9 May 2007 MEB NARSUM examination, 9 months prior to separation, noted complaints of low back pain radiating to the left hip and knee and toe numbness with prolonged standing.  Pain was exacerbated by prolonged sitting, prolonged standing, and activity and was relieved with Ibuprofen 800mg.  The CI did not have any emergency room visits or hospitalizations within the last year.  The physical examination documented a normal gait and strength, sensation, and DTRs were also normal.

At the VA Compensation and Pension (C&P) examination in April 2008, performed 4 months after separation, the CI reported rare mild pain and some weakness with no radiation, numbness, incontinence, or erectile dysfunction.  The CI reported not needing a brace, cane, or crutch.  His medications included 800mg of Ibuprofen which provided relief.  He reported no physician directed bedrest and no flare-ups.  The physical examination documented no limp or assistive device.  The thoracolumbar spine examination revealed a normal contour and well-healed scars with no tenderness or spasm.  Pain-free ROM values of flexion 80 degrees (normal 90) and combined ROM 230 (normal 240) and straight leg raise tests were negative.  The ROM was not additionally limited by pain, fatigue, weakness, or lack of endurance following repetitive use.  Strength, sensation, and deep tendon reflexes were normal.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back condition 10%, coded 5243 (intervertebral disc syndrome).  The VA also rated the low back condition 10%, also coded 5243 based on the VA C&P examination 4 months after separation, citing limited motion.  The Board agreed that a 10% rating, but no higher, was justified for limitation of flexion (greater than 60 degrees but not greater than 85 degrees) and/or combined ROM (greater than 120 degrees but not greater than 235 degrees) reported on the MEB NARSUM and VA examinations proximate to separation.  There was no evidence of intervertebral disc syndrome which resulted in incapacitating episodes requiring physician-prescribed bed rest to warrant consideration of rating under the alternate VASRD formula.  The Board also considered if additional disability rating was justified for peripheral nerve impairment due to radiculopathy.  While the CI reported back pain with associated weakness, numbness, and tingling in his legs, there was no incontinence, no erectile dysfunction, straight leg raise tests were negative, and strength, sensation, and deep tendon reflexes were normal.  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 impairment (such as weakness) that directly impacted fitness for duty.  The Board therefore concluded that an additional disability rating was not justified on this basis.

The Board also considered if additional disability rating was justified for the CI’s residual surgical scars.  The Board does not recommend disability rating for scars unless their presence imposes a direct functional limitation that renders the CI unfit.  Serial examinations revealed well-healed scars and the lumbar scars did not interfere with wear of military gear and were not painful at the MEB NARSUM examination.  Any contribution from the scars on ROM limitation was addressed above.  There was insufficient evidence of duty-limiting impairment from the lumbar scars, thus the Board concluded that the scar condition could not be recommended for additional disability rating.  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 chronic low back pain condition.

BOARD FINDINGS:  In the matter of the chronic low back pain with radiculopathy, status-post microdisketomy of L4-5 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 following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140610, 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-2014-03852.

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