RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00158
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20080513

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Aircraft Structural Maintenance Craftsman, medically separated for “chronic low back pain,” with a disability rating of 20%.  

CI CONTENTION:  “Please consider all conditions.”  The CI’s complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The panel’s scope of review is defined in DoDI 6040.44.  It is limited to review of disability ratings assigned 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 or non-compensable.  Any conditions outside the Panel’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 panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical conditions at the time of separation.  The panel has neither the role nor the authority to compensate for progression or complications of service connected conditions after separation.  That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws.  The panel 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 - 20080331	VARD - 20080825	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5243	20%	Degenerative Disc Disease of the Thoracolumbar Spine	5237	20%	20080618	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain (LBP).  According to the service treatment record (STR), the CI’s low back condition began while on deployment in April 2005 with no history of injury.  Electrophysiologic studies in September 2006 documented a left-sided L5 radiculopathy.  Magnetic resonance imaging (MRI) in October 2006 documented degenerative disc disease (DDD) at the L5 and S1 vertebral levels with spinal stenosis (narrowing).  There was no surgical indication, and conservative treatment (medications, physical therapy and spinal injections) did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “chronic low back pain due to lumbar radiculopathy from disc disease” for PEB adjudication.  

At the neurology visit in January 2008, the physical examination showed “unchanged findings” of tenderness of the bilateral paraspinal muscles, decreased sensation in the left lower extremity, evidence of nerve tension bilaterally, decreased motor strength to 4/5 that was “limited due to pain,” and ambulation without assistance that was “slow and limited due to pain.”  Three days of physician-prescribed bedrest was given in February 2008 after receiving back injections and experiencing “complications.”  

At a March 2008 physical therapy visit, ranges of motion (ROM) were recorded to show a forward flexion of 50 degrees (normal 90) limited by pain, with a total combined ROM of 180 degrees (normal 240).  There was no STR documentation showing thoracolumbar spine forward flexion of 30 degrees or less.  

At the 18 June 2008 VA Compensation and Pension (C&P) evaluation, performed 1 month after separation), the CI reported constant pain, stiffness, weakness, and spasm, with radiation to both legs.  He reported weekly flare ups that lasted hours with no incapacitating episodes over the previous 12 months, and intermittent use of a cane.  The physical examination showed guarding, tenderness, and painful motion with no evidence of spasm, weakness or abnormal curvature.  Flexion was to 45 degrees with pain, and extension was to 20 degrees, with no additional loss of ROM after repetition.  There was a normal strength, reflex, and sensory examination.  

The panel directed attention to the rating recommendation based on the above evidence.  The PEB rated 20% for the LBP, coded 5243 (intervertebral disc syndrome [IVDS]), citing a normal neurologic examination.  The VA also rated 20% for the LBP, coded 5237 (lumbosacral strain), citing limitation of forward flexion.  The VA also granted an additional 0% rating each for a left and a right radiculopathy associated with DDD of the thoracolumbar spine, coded 8520 (sciatic nerve, paralysis of, incomplete), and citing no objective clinical findings.  

The panel 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 physical therapy and VA examinations.    There was no STR or VA evidence of flexion less than 30 degrees in support of a higher rating. There was no evidence of IVDS resulting in incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks in support of a higher rating under the alternate VASRD formula.  

The panel also considered if additional disability rating was justified for peripheral nerve impairment due to radiculopathy.  The CI had a herniated disc with radicular pain, and there were symptoms of radiating pain documented in the treatment records.  Some examinations indicated normal strength, reflexes and gait; while other examinations documented abnormal gait.  The January 2008 neurology visit documented sensory changes and diminished strength, however the June 2008 VA examination noted a normal strength, reflex, and sensory examination.  Radiographic and electrodiagnostic studies supported some level of radicular nerve irritation or involvement, but physical examinations (neurology and VA C&P) 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 panel’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 panel 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 panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the LBP condition.  

PANEL FINDINGS:  In the matter of the chronic LBP condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  There were no other conditions within the panel’s scope of review for consideration.  The panel, 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 20140717, w/attachments
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

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2015-00158.

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,

XXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings