RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00225
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20040218

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a National Guard E6, Aircraft Loadmaster, medically separated for “low back pain,” with a disability rating of 20%.  

CI CONTENTION:  The CI contends his back and left knee (leg) conditions as well as scars. The 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 condition(s) 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 - 20030818	VARD -  20041029 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Low Back Pain	5295	20%	Residuals Discectomy Thoracolumbar Spine with Degenerative Disc Disease	5242	20%	20040816	
			Scar, Low Back	7804	10%		
			Left Lower Extremity Radiculopathy	8520	0%		
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY: 
 
Low Back Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s low back condition began in 1999 after falling during the abrupt stop of a taxiing C-130.  Magnetic resonance imaging demonstrated an L5-S1 herniated disc with S1 nerve root impingement.  An initial surgery in April 2000 did not result in complete resolution.  Following a second surgery in July 2002 and further treatments, the CI’s condition did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “low back and left leg pain” for PEB adjudication.  

At the 21 July 2003 MEB NARSUM examination, 7 months before separation, the CI reported daily pain in the back, groin, and left leg, with numbness of the foot, and leg fatigue.  The physical examination showed tenderness and a “50-75%” decrease in range of motion (ROM).  
The orthopedic 6 October 2003 NARSUM addendum examination, 5 months before separation, noted the CI’s report of persistent leg pain, weakness, and numbness.  

At the 16 August 2004 VA Compensation and Pension examination, 6 months after separation, the CI reported radicular pain and testicular ache.  The physical examination showed forward flexion of 45 degrees (normal 90) and a combined ROM of 145 degrees (normal 240), with painful motion throughout.  The gait, reflexes, and sensory examinations were normal.  Electromyography studies dated 10 March 2004 showed no evidence of radiculopathy.  

The panel directed attention to the rating recommendation based on the above evidence.  The PEB rated 20% for the low back condition using the 2003 Interim VASRD spine rules under the 5295 code (lumbosacral strain).  The VA also assigned a 20% rating using the 2003 New VASRD guidelines under the 5242 code (degenerative arthritis of the spine) for limitation of forward flexion.  

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) and combined ROM (not greater than 120 degrees), as reported on the MEB NARSUM and VA examinations.  There was no documentation of periods of incapacitating episodes which would provide for a higher rating under that formula.  There was no evidence in this case that motor weakness or sensory impairment existed to any degree that could be described as functionally impairing; and therefore, no evidence for an additional or higher rating.  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 low back condition.  

Contended PEB Conditions:  Left Knee Medial Meniscal Tear and Patellar Chondromalacia.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  None of the conditions were profiled or implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that any of the conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for either of the contended conditions and so no additional disability ratings are recommended.  

PANEL FINDINGS:  In the matter of the low back pain condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the contended left knee meniscal tear and patellar chondromalacia conditions, the panel unanimously recommends no change from the PEB determination as not unfitting.  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 20150319, 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

XXXXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2015-00225.

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,

XXXXXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings