RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00475
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20021112

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Avionics Systems Journeyman, medically separated for “chronic lower back pain” rated 10%.  

CI CONTENTION:  The CI indicates his back condition has led to arthritis and sciatica, and all three conditions continue to affect his life.  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 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 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 - 20020917	VARD - 20030310	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Lower Back Pain	5295	10%	Chronic Lumbar Spine Strain	5295-5292	10%	20030125	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Chronic Lower Back Pain.  According to service treatment records (STRs) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s low back pain condition began in April 2000 with no history of major trauma.  He was treated with muscle relaxants, narcotics, and nonsteroidal anti-inflammatory drugs (NSAIDs) and at times with no medication.  Conservative treatment with physical therapy was unsuccessful.  The CI had a 3 day history of lower back pain after standing up from a couch when he stood up and had similar symptoms when weight lifting. Magnetic resonance imaging (MRI) on 24 May 2001 showed a 3 mm right neural foraminal protrusion at T10-11, a 2 mm broad posterior bulge/protrusion at T11-12, an L3-L4 disc 4mm broad posterior downward protrusion that indented the thecal sac with mild posterior element hypertrophy with no definite stenosis or impingement, and 1 mm bulges at L4-5 and L5-S1. Neurosurgical evaluation in July 2001 indicated the CI had pain for the last 1 year usually related to lifting weights in the gym.  Since May 2001 the CI continued to have severe pain without bowel or bladder symptoms that increased with physical activity and decreased with rest.  Examination was unremarkable with a normal gait and full muscle strength in all extremities.  Physical therapy provided no relief.   Neurosurgical evaluation in December 2001 noted the CI complained of low back pain and spasm and the pain that went down the left leg to the knee.  The neurosurgeon recommended no surgical intervention, but did recommend lumbar facet blocks; however, the CI wanted to refrain from undergoing any injections at that time.  Retraining was also recommended.  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 a MEB. The MEB forwarded “chronic low back pain” for PEB adjudication.  

Electrodiagnostic testing in August 2001 revealed fibrillation potentials in the left lateral gastrocnemius consistent with an L5-S1 radiculopathy.  Neurosurgical evaluation in August 2001 revealed the CI had a relatively antalgic gait and his range of motion (ROM) of the lumbar spine was normal.  Pain could not be reproduced with any particular maneuver aside from simple palpation of a trigger point located approximately 5 cm off midline just above the left iliac crest, which with deep pressure at that point produced pain that radiated into the buttock and low back.  Muscle strength of the lower extremities was normal except some mild give-way weakness in his left iliopsoas [muscle].  No sensory disturbance was present.  A repeat MRI and trigger point injections were recommended.  An MRI in August 2002 demonstrated mild disc degeneration and a 4 mm broad posterior protrusion exhibiting a tiny inferior annular tear and indenting the thecal sac centrally and abutting the left L3 ganglion with mild central canal and lateral recess stenosis.  Examination in May 2002 reported the low back pain was stable.  At the NARSUM examination on 5 September 2002, 2 months prior to separation, the CI had no tenderness to palpation or limitation of the ROM.    

At the 25 January 2003 VA Compensation and Pension (C&P) evaluation, performed 2 months after separation, the CI reported he had not missed any work since he had been out of the military.  Sitting was not a problem; walking and standing could be a problem.  He took Aleve (naproxen, an NSAID) once or twice a week.  He had no flare-ups, but the pain seemed to be pretty persistent and consistent.  The physical examination revealed a forward flexion to 90 degrees, extension 10 degrees, lateral bending left and right 25 degrees, and rotation left and right 25 degrees, all performed asymptomatically; and there was no functional loss on repetition. The examiner was unable to recreate or notice weakness in his left leg, which the CI expressed. The examiner opined the bulk of the CI’s problem was just more of a functional type problem of chronic musculotendinous and ligamentous strain.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic lower back pain condition 10%, coded 5295 (lumbosacral strain with characteristic pain on motion).  The VA rated the chronic lower back pain condition 10% coded 5295-5292 (lumbosacral strain-spine, limitation of motion of, lumbar), based on the VA C&P examination 2 months after separation, citing a forward flexion to 90 degrees.  Board members considered whether a 20% rating using code 5295 was warranted; however, there was no muscle spasm on extreme forward bending or loss of lateral spine motion in standing position. Furthermore, use of code 5292 requires moderate limitation of motion; however, the CI had a full ROM.  There was no documentation of intervertebral disc syndrome (IVDS) with “symptoms compatible with sciatic neuropathy with characteristic pain and demonstrable muscle spasm, absent ankle jerk, or other neurological findings appropriate to site of diseased disc, little intermittent relief,” which would provide for a higher rating under that formula (for IVDS).  The Board also considered if an additional disability rating was justified for peripheral nerve impairment due to radiculopathy.  Radiographic and electrodiagnostic studies supported some level of radicular nerve irritation or involvement, but 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.  The critical decision is whether or not there was a significant motor weakness which would impact military occupation-specific activities.  There was no evidence in this case that motor weakness existed to any degree that could be described as functionally impairing.  Thus, the Board concluded that an 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 lower back pain condition.  

BOARD FINDINGS:  In the matter of the chronic lower 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 20150601, 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-2015-00475.

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