RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX  	CASE:  PD-2014-03917
BRANCH OF SERVICE:  Air Force	SEPARATION DATE:  20081028

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E5, Security Forces Journeyman, medically separated for “chronic low back pain,” with a disability rating of 10%.

CI CONTENTION:  The CI has requested consideration of 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 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 – 20080829	VARD - 20090205	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain, Status Post T-10 Compression Fracture	5235	10%	Status Post Compression Fracture with Thoracolumbar Degenerative Disc Disease and Bilateral Lower Extremity Radiculopathy	8520-5243	10%	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain.  According to service treatment records (STRs) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI had a history of chronic low back pain which was exacerbated by a vehicular accident in 2004 while deployed to Iraq (treated in theater).  The pain persisted on redeployment without an initial complaint of radicular symptoms, although there was a later complaint of right lower extremity pain and paresthesias.  Serial magnetic resonance imaging demonstrated a stable “mild” compression fracture (anterior wedge at T-11) and disc disease (L4/5, “far right lateral” protrusion with some encroachment on the right nerve root).  Multiple normal neurological examinations were evidenced in the STR, and surgery was not recommended.  There were multiple STR entries documenting grossly normal range of motion (ROM) with none indicating severe ROM limitation.  There were multiple STR entries documenting a normal gait, with none to the contrary, and none suggesting abnormal spinal contour; and, there was no STR evidence of incapacitating episodes.  Conservative treatment did not result in improvement sufficient to allow unrestricted duty. The MEB forwarded “compression fracture, T-10,” “thoracic back pain” and “lumbago” to the PEB for adjudication.

The NARSUM examination on 27 February 2008 (8 months prior to separation) noted complaints of back pain and “intermittent right leg numbness,” with no mention of subjective weakness, and documented that the CI was still able to pass physical fitness testing (including 1.5 mile run), albeit with pain.  The physical examination recorded a normal gait, tenderness, and normal neurological findings (5/5 strength all groups).  Formal goniometric ROM measurements for the MEB were conducted by physical therapy eight days prior to the NARSUM, which documented flexion to 85 degrees (normal 90) and combined ROM of 200 degrees (normal 240).  Subsequent full ROM measurements from a chiropractic examiner (14 May 2008, 5½ months prior to separation) were also in evidence, which documented flexion to 70 degrees and combined ROM of 175 degrees.  

The CI failed to show for a scheduled VA rating examination, although two outpatient VA entries (1 month and 5 months after separation) documented grossly normal ROM, normal gait, and normal neurological findings.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated 10% coded 5235 (vertebral fracture or dislocation), citing compression fracture, limitation of motion with pain, and tenderness.  The VA provided a 10% rating under 8520-5243 (paralysis of the sciatic nerve - intervertebral disc syndrome), based on STR evidence, citing tenderness of the thoracolumbar spine.  Both the PEB and VA decisions indicated that the radicular component was subsumed within the spine rating.  There was no ROM evidence supporting a rating higher than 10%, no evidence for abnormal gait or contour to support a 20% rating, and no documentation of incapacitating episodes which would provide for a higher rating under that formula.  The Board specifically considered if additional disability rating was justified for peripheral nerve impairment due to radiculopathy.  The presence of functional impairment with a direct impact on fitness is the key determinant in the Board’s decision to recommend any condition for rating as additionally unfitting.  While the CI may have suffered additional pain from the nerve involvement, 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 motor weakness or sensory deficit in evidence, thus there was no indication of significant functional impairment.  The Board therefore concluded that additional disability rating was not justified on this basis.  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 of the lumbar spine condition.  

BOARD FINDINGS:  In the matter of the lumbar 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 20140829, 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-2014-03917.

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