RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00685
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20020801

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

CI CONTENTION:  The CI contends that his condition continues to worsen and negatively impacts his daily activities.  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 - 20020426	VARD - 20030403	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Lower Back Pain	5295	20%	Residuals of L5-S1 Fusion with Sciatica	5295	20%	20030318	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Chronic Lower Back Pain.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent back surgery with laminectomy and fusion of L5-S1 in November 2000 for a herniated disk, spondylosis and spondylolysis, and lumbar radiculopathy.  The CI had a period of relief following surgery, with return of symptoms in 2002 (post-laminectomy pain syndrome).  Further treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “low back pain s/p L5-S1 fusion” for PEB adjudication.  

At the neurological evaluation performed on 27 March 2002, 4 months prior to separation, the CI complained of severe low back pain and bilateral hip pain.  There was no complaint of weakness, numbness, foot-drop or bowel or bladder incontinence.  Exam documented an antalgic gait without any abnormal focal neurologic findings.  Electrodiagnostic studies (EMG/NCV)] performed the same day documented complaints of low back pain radiating into both legs.  Result showed slight changes in the left sural nerve and concluded with “essentially normal” findings for the bilateral lower limbs.  Medications in March 2002 included Flexeril, Ultram, and Vicodin (muscle relaxant; narcotic-like; and narcotic pain medication) without significant relief.  The MEB NARSUM examination on 2 April 2002, 4 months prior to separation, noted complaints of worsening low back pain and left lower extremity pain.  Back pain was worsened with standing, and decreased with forward flexion or laying down.  Physical examination showed a stiff posture with significant paraspinal muscle tenderness to palpation, with increased pain with low pelvic range of motion, especially in extension.  Surgical scar was well healed.  Motor, reflex, and sensory testing was normal bilaterally.  Straight leg raise (SLR) testing was negative for radiating symptoms.  

The commander’s statement dated 18 April 2002 stated that the CI’s back condition severely limited him and “the pain can be so severe that (the CI) is only able to work 2-3 hours at a time;” although he could handle tasks that would allow him to sit and use a computer.  The CI submitted a letter of disagreement dated 30 April 2002 (after the PEB) describing his severe pain and work limitations.  [There was no Formal PEB in evidence; a memo extract indicated that on 13 June 2002, officials within the office of the Secretary of the AF determined the CI was physically unfit for continued military service and directed discharge with severance pay.]  

At the 18 March 2003 VA Compensation and Pension (C&P) Spine evaluation, performed 7 months after separation, the CI reported constant 5/10 pain in his lower back with pain to 9/10 with repetitive movement and flare-ups.  The CI denied radiating pain to his legs.  Back pain was exacerbated by standing, walking and bending, and relieved with narcotic (Vicodin) pain medication.  Diagnostic imaging (MRI) revealed degenerative changes of L5-S1.  Physical exam recorded flexion of 90 degrees with pain starting at 45 degrees and painful extension, rotation and lateral bending to 30 degrees.  The CI had pain at 45 degrees with SLR testing.  The examiner stated “with recurrent motion, excess fatigability against moderate resistance of the lumbar spine.  …  He has sciatica.”  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 20%, coded 5295 (Lumbosacral strain).  The VA also rated the back condition 20% coded 5295, based on the VA C&P examination 7 months after separation, citing pain and limitation on motion.  In accordance with DoDI 6040.44, the Board is required to recommend a rating IAW the VASRD in effect at the time of separation. The Board noted that the 2001 VASRD standards for the spine, which were in effect at the time of separation, were changed in September 2002 regarding code 5293 (to the incapacitating episodes criteria), and then changed to the current §4.71a rating standards in September 2003.  The Board correlated the above clinical data with the 2001 rating schedule; applicable diagnostic codes include: 5292 (limitation of lumbar spine motion); 5293 (intervertebral disc syndrome); and 5295 (lumbosacral strain).  The applicable coding options for this case are excerpted below:  

5292 Spine, limitation of motion of, lumbar
Severe ...................................................................................................................................... 40
Moderate ................................................................................................................................. 20
Slight ........................................................................................................................................ 10

5293 Intervertebral disc syndrome:
Pronounced; with persistent 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 ............... 60
Severe; recurring attacks, with intermittent relief .................................................................. 40
Moderate; recurring attacks .................................................................................................... 20
Mild .......................................................................................................................................... 10
Postoperative, cured .................................................................................................................. 0

5295 Lumbosacral strain:
Severe; with listing of whole' spine to opposite side, positive Goldthwaite's sign,
marked limitation of forward bending in standing position, loss of lateral motion
with osteo-arthritic changes, or narrowing or irregularity of joint space, or some
of the above with abnormal mobility on forced motion ......................................................... 40
With muscle spasm on extreme forward bending, loss of lateral spine motion, unilateral,
in standing' position ................................................................................................................ 20
With characteristic pain on motion ......................................................................................... 10

There was no evidence of limited motion sufficient to warrant a higher rating under code 5292, or code 5295; therefore the Board considered alternative rating under code 5293 as the CI had symptoms of intervertebral disc syndrome (sciatica).  Of special note, the VARD indicated the VA rating considered only the 5293 VASRD criteria for incapacitating episodes that became effective in September 2002—after the CI’s date of separation and prior to the date of VA rating.  

The Board deliberated if the CI’s back pain condition more nearly approximated the 2001 VASRD 40% criteria for severe intervertebral disc syndrome with intermittent relief, or moderate symptoms with recurring attacks.  Proximate to separation there was scant objective evidence of sciatic neuropathy with characteristic pain radiating below the knees, no weakness or loss of reflexes, and no fixed neurological deficits.  The CI had relief of pain with medication, sitting and restricting physical activities.  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 20150603, 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-2015-00685.

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