RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00290
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20011123

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Precision Measurement Equipment Lab Journeyman, medically separated for “chronic low back pain status post laminectomy with associated spondylosis at 2 levels,” with a disability rating of 20%.  

CI CONTENTION:  He was given a higher rating for his condition by the VA.  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 based upon a 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 - 20011001	VARD - 20020508	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain Status Post Laminectomy with Associated Spondylosis at 2 Levels	5293	20%	Chronic Low Back Pain Status Post Laminectomy 	5292	40%	20011105	
COMBINED RATING: 20%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain Status Post Laminectomy with Associated Spondylosis at Two Levels.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s chronic low back condition began in September 2000 after playing softball.  The CI denied any specific injury or trauma.  Surgery was performed 17 April 2001 after radiographic (MRI) and electrodiagnostic studies (EMG) demonstrated compression of the S1 nerve root and evidence of a right lower extremity radiculopathy.  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 an orthopedic examination 16 July 2001, (3 months post-operative and 4 months before separation), the examiner documented a lumbar flexion of 40 degrees (normal 60 for isolated lumbar flexion) and extension of 10 degrees with no tenderness and normal neurologic examination.  Radiographic imaging (MRI) in August 2001 showed post-surgical changes without herniation at L5-S1.  There was an L4-L5 disc bulge into the spinal canal, degenerative joint disease, and a minimally bulging disc at the L3-L4 with no evidence of nerve impingement.  In August 2001, the CI was prescribed 3 days of bedrest for a flare up of pain and radiculopathy.  

At the time of the orthopedic MEB consult on 27 August 2001 (3 months before separation), the CI described himself as “30-40% better” with intermittent low back pain that prevented him from returning to work.  The physical examination showed lumbosacral tenderness, flexion to 60 degrees, extension to 20 degrees with no neurologic deficits and no evidence of sciatica.  Gait, spasm, spinal contour and painful motion were not addressed.  

At the MEB NARSUM examination dated 4 September 2001, the CI reported inability to lift greater than 20 pounds, and pain requiring narcotics that caused him to miss work.  The physical examination showed lower lumbar tenderness, and “limitation of flexion.” There was normal strength and reflex testing with decreased sensation over the right lateral thigh.  Gait, spasm, spinal contour and painful motion were not addressed.  

At the VA Compensation and Pension (C&P) examination on 5 November 2001 (1 month before separation), the CI reported chronic pain that radiated to the right posterior leg, morning stiffness and evening spasms.  The pain prevented bending, lifting more than 15 pounds, and interfered with sleeping two nights a week.  Flares were precipitated by improper bending and would incapacitate him for 1 day, resulting in 3 days lost from work per month.  The physical examination showed a normal gait with no lumbar tenderness.  Flexion was to 30 degrees with spasms (“patient did not bend further”).  Bilateral rotation was to 10-15 degrees right lateral flexion was normal and left lateral flexion was to 15 degrees.  Spinal contour was not addressed.  

The Board directed attention to the rating recommendation based on the above evidence.  The PEB rated the chronic low back pain condition 20% coded 5293 (intervertebral disc syndrome).  The VA rated the chronic low back condition 40% coded 5292 (limitation of motion of the lumbar spine), based on the VA C&P examination (1 month before separation), citing severe limitation of motion of the lumbar spine.  

At the time of separation in November 2001, the 2002 standards for rating based on ROM impairment were subject to the rater’s opinion regarding degree of severity; whereas, the current standards specify rating thresholds in degrees of ROM impairment.  When older cases have ROMs in evidence, the Board reconciles (to the extent possible) its opinion regarding degree of severity for the older spine codes.  

The Board deliberated the probative value of the examinations in evidence and the totality of the record.  The orthopedic examination in July 2001 specified the lumbar ROM as 40 degrees of flexion, which would support a rating of 20% for “moderate” lumbar limitation of motion under 5292 (2002 criteria).  At the orthopedic MEB visit in August 2001, the examiner documented flexion at 60 degrees, which would support a rating of 10% for “slight” lumbar limitation of motion under 5292 (2002 criteria).  The VA C&P examination documented that the CI did not bend further after spasms that occurred at a forward flexion of 30 degrees.  Members agreed that refusal to attempt spine excursion to full painful limits does not meet an acceptable standard for a ratable measurement.  There was no documentation of tenderness, abnormal gait or abnormal spinal contour that would be described as a “severe” limitation of motion.  In considering coding under intervertebral disc syndrome (5293), the CI reported 3 days lost from work on a monthly basis, however, there was no documentation of “severe; recurring attacks, with intermittent relief” for a rating higher than 20%.  

The Board agreed that the July and August 2001 examinations (conducted by orthopedics) were adjudged to have the highest probative value for rating at separation.  The documented limitation of flexion of 40 that subsequently improved to 60 degrees would not support a rating higher than 20% under the 2002 VASRD criteria.  

Based on the examinations in evidence, the Board agreed that a rating higher than 20% could not be recommended.  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 low back pain condition.  

BOARD FINDINGS:  In the matter of the chronic low 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 20150429, 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-2015-00290.

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