RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-04311
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20060911

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E5, Network Journeyman, medically separated for “chronic back pain, possible facet syndrome,” with a disability rating of 20%.

CI CONTENTION:  The CI’s condition continues to worsen and negatively impacts his daily activities.  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 – 20060727	VARD - 20061115	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Back Pain …	5299-5242	20%	Degenerative Joint Disease, Lower Back	5242	20%	20061018	
			Left Lower Extremity Radiculopathy Associated with Degenerative Joint Disease, Lower Back	8520	10%		
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Chronic Back Pain.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s low back pain condition began in September 2001 after feeling a pop in his back while moving farm equipment.  The CI underwent surgery (radiofrequency ablation) in January 2006 to his reduce pain.  Following surgery further treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “chronic low back pain” for PEB adjudication.  At the time of the orthopedic clinic appointment on 16 February 2005, the CI reported lower back pain with numbness and tingling down the lower extremities.  The examiner noted normal sensation.  At a neurosurgery examination, on 27 July 2005, the CI reported persistent lower back pain.  He denied lower extremity pain, numbness, tingling, and weakness.  Physical examination showed a normal sensory examination.  The examiner rendered a diagnosis of mechanical lower back pain.  A physical therapy evaluation in March 2006 documented normal gait and posture.  In November and December 2005, the CI received 3 epidural injections (branch blocks) which did not relieve his pain.  The MEB NARSUM examination on 16 May 2006 (4 months prior to separation) noted complaints of fluctuating back pain.  Physical examination showed normal sensation and gait.  The examiner documented forward flexion as finger tips 2 inches below the knee joint line.  At the VA Compensation and Pension (C&P) examination on 18 October 2006, performed 2 months after separation, the CI reported he continued to experience pain with numbness in his left foot.  Physical examination showed reduced flexion to 45 degrees (normal 90). Posture and gait were normal without muscle spasm.  The examiner also noted the Achilles reflexes were diminished with definite sensory and motor loss on the left.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic back pain condition 20% analogously coded 5299-5242 (Degenerative Arthritis of the Spine), citing limitation of motion.  The VA also rated the chronic back pain condition 20% coded 5242, based on the VA C&P examination 2 months after separation, citing limitation of motion.  The VA rated a left lower extremity radiculopathy condition 10% coded 8520 (Incomplete Paralysis of the Sciatic Nerve), citing some motor and sensory loss. 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), reported on the NARSUM range of motion examination, as interpreted by the formal PEB and VA examinations.  Although at the VA C&P examination the CI reported left leg numbness and tingling and the examiner noted a definite motor and sensory impairment of the left lower extremity, the majority of physical examinations proximate to separation revealed no objective findings of radiculopathy that would impact duty performance.  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).”  Therefore the critical decision is whether or not there was a significant motor weakness which would impact military occupation specific activities.  There is no evidence in this case that motor weakness existed to any degree that could be described as functionally impairing.  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 for the chronic back pain condition.  

BOARD FINDINGS:  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.  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 20141120, 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-2014-04311.

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