RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00012
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20070220

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E4, Computer Systems Planning and Implementation Journeyman, medically separated for “chronic low back and radicular pain with lumbar spondylosis” with a disability rating of 10%.

CI CONTENTION:  “Please consider 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 - 20070104	VARD - 20070816	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back and Radicular Pain with Lumbar Spondylosis	5242	10%	Lumbar Spondylosis with Radiculopathy	5243	10%	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS: 40%	

ANALYSIS SUMMARY:  

Chronic Low Back and Radicular Pain with Spondylosis.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI suffered from hip pain sometime in the spring of 2005.  There was no history of injury or trauma.  Radiographic studies including X-rays showed no hip pathology.  Magnetic resonance imaging (MRI) studies dated 6 April 2006, showed lumbar degenerative disc disease with a bulging intervertebral disc at L4-5.  Electrodiagnostic studies (EMG/NCV) dated 5 June 2006 were negative for radiculopathy. Evaluation by neurology concluded with a diagnosis of lumbar radicular syndrome.  Orthopedic evaluation indicated that there was no surgical indication.  Despite treatment, the back condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for MEB.  The MEB forwarded “lumbar radiculopathy, lumbar spondylosis, [and] chronic low back pain” for PEB adjudication.  At the time of the civilian pain management clinic appointment on 7 August 2006, 6 months before separation, the CI reported “that his pain [was] fairly well controlled on his current medication regimen…”  The examiner noted the CI had “flattening of the lumbar lordosis.” Although there were no actual ROM measurements recorded, the CI had pain with “flexion, extension, lateral bending and rotational movement of the lumbar spine.”  There was also pain with palpation of the lumbosacral spine.  He had normal motor strength, reflexes and gait.  The physical therapy (PT) MEB ROM study, dated 14 September 2006, 5 months before separation, showed that the ROM of the CI’s lumbar spine was “100%” in all planes of motion.  The examiner noted that the CI had “pain and tension with postural deficits noted in thoracic spine…” as well as “some pain with manual muscle testing.”  At the MEB NARSUM examination, dated 3 October 2006, 5 months prior to separation, the examiner recorded that the CI was unable to do any type of fitness program, perform pushing and pulling activities, climb stairs or run.  Physical examination showed that “pain was elicited by active motion” and that “ROM [seemed] to be normal.”  There was “no tenderness to palpation of the hip or trochanteric bursa.”  There were no other examination findings listed by the examiner.  At the second MEB NARSUM examination, dated 21 November 2006, 3 months prior to separation, the examiner recorded that the CI was unable to do any type of fitness program, perform pushing and pulling activities, climb stairs or run.  Physical examination showed that “pain was elicited by active motion.”  “There was no tenderness to palpation of the hip or trochanteric bursa” and there was “full range of motion” of the hips.  For the lumbar range of motion findings, the examiner referred the reader to the PT ROM study dated 14 September 2006.  There were no other examination findings listed by the examiner.  There was no VA Compensation and Pension (C&P) examination conducted proximate to separation.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10% coded 5242 (degenerative arthritis of the spine).  The VA also rated the back condition 10%, but coded it 5243 (intervertebral disc syndrome), citing “localized tenderness and chronic low back pain.”  Although there was no evidence of limitation of motion to support a minimum rating, the Board agreed a 10% rating was justified for the presence of painful motion and/or tenderness.  Although there was evidence of abnormal spinal contour, there was no muscle spasm or guarding noted on any of the examinations, thus the next higher 20% rating was not justified on this basis.  The Board considered whether a higher rating (§4.7) was achieved by using the alternate rating formula based on incapacitating episodes due to intervertebral disc syndrome.  Although the CI had intervertebral disc disease, there was no evidence of incapacitating episodes requiring bed rest prescribed by a physician to warrant consideration of rating under the alternate VASRD formula based on incapacitating episodes due to intervertebral disc syndrome.  The Board also considered if additional disability rating was justified for peripheral nerve impairment due to radiculopathy.  The CI had symptoms of radiating pain documented in the treatment records; however, examinations indicated normal strength, reflexes and gait.  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 was no evidence of lumbar nerve root involvement by MRI, electro-diagnostic studies, or neurologic examination.  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 back condition.  

BOARD FINDINGS:  In the matter of the back 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 20141219, 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-2015-00012.

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