RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00744
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20070924

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Signals Analyst, medically separated for “chronic low back pain (LBP) with chronic left-sided sciatica, status post (s/p) fusion of L4-5” with a disability rating of 20%.  

CI CONTENTION:  “Review 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.  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 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 panel 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 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 - 20070813	VARD - 20080103	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic LBP…Left-Sided Sciatica, s/p Fusion of L4-5	5241	20%	Degenerative Disc disease L4-5, s/p Laminectomy and Multiple Fusion, with Radiculopathy	5242	10%	20071002	
			Scars s/p Lumbar Surgery	7804	10%		
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Chronic LBP… Left Sided Sciatica, S/P Fusion of L4-5.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s back condition began in late 2000 after a motor vehicle accident.  The CI underwent four back surgeries: L4-5 nerve root decompression (3 June 2003), L4-5 microdiscectomy (13 June 2005), mini open microdiscectomy (21 March 2006) and minimum invasive transforaminal lumbar interbody fusion (TLIF) (13 December 2006).  
During the 9 May 2007 MEB NARSUM examination, 5 months prior to separation, the CI reported complaints of chronic LBP and buttock pain.  The examiner noted that the CI had sacroiliac joint dysfunction for which she had received joint injections twice from the pain clinic and ongoing physical therapy, without real relief.  The physical examination showed that her gait was near normal.  She sat leaning to her right shifting weight onto her right buttock.  Cervical spine motion was normal.  Examination of her back revealed three vertical scars.  One was midline over the low lumbar area.  The second was 3 cm right of midline and a third was 3 cm left of midline.  All were about 4 cm in length and were well healed.  The thoracolumbar spine was measured as a unit, i.e., from T1 - L5 with an inclinometer.  Flexion of the lumbar spine was limited with a firm endpoint attributable to muscle tightness in the paraspinal muscles.  Forward flexion was 45 degrees (90 normal).  She was more comfortable leaning to left than to right.  The CI’s straight leg raise was normal on the right and limited by buttock pain to 60 degrees on the left.  She had abnormally decreased sensitivity to stimuli, particularly to touch along the medial aspect of her left forefoot and great toe and could not distinguish pin prick from touch in the L4-5 nerve distribution.  

At the 2 October 2007 VA Compensation and Pension (C&P) evaluation, 9 days after separation, the CI reported constant LBP with frequent radiation down the left lower extremity with numbness and tingling in the left foot.  The CI also noted a tingling sensation every time a surgery scar was touched.  The physical examination revealed three 1½-inch well-healed surgical incisions.  There was no tenderness or paraspinal spasm.  Straight leg raise was negative bilaterally.  There was a moderate decrease in pin sensation in the left L5 dermatome.  Range of motion (ROM) in degrees showed forward flexion of 85 (90 normal), backward extension 30 (30 normal), right and left lateral flexion 30 (normal), right and left rotation 45 degrees (30 normal).  There is no objective evidence of pain on motion.  The patient arose and stood normally.  Gait was normal.  Examination of the CI’s surgical back scars revealed three, almost identical, vertical surgical scars on her lower back.  The one was in midline which about 4 cm long, and the other two were parallel to it on each side and they are also 4 cm long.  They were non-tender, except “maybe” slightly sensitive to touch.  The scars were smooth, not adherent, had no ulceration, no elevation, no disfigurement, no loss of tissue, or inflammation.  Color was slightly darker than surrounding skin.  There was no limitation of function due to these scars.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the LBP with sciatica condition 20%, coded 5241 (spinal fusion).  The VA rated the back with radiculopathy condition 10%, coded 5242 (degenerative arthritis of the spine), based on the C&P examination 9 days after separation, citing forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees.  The panel noted the MEB examination ROM values for the lumbar spine were performed using an inclinometer and not the goniometric thoracolumbar ROM specified by the VASRD (§4.71a, Plate V).  Additionally, the examiner reported only the lumbar flexion of 45 degrees and not the normal combined thoracolumbar ROM.  

In this case, the LBP and the sacroiliac joint dysfunction are closely related conditions.  In accordance with VASRD §4.66 (sacroiliac joint) which stipulates, “The lumbosacral and sacroiliac joints should be considered as one anatomical segment for rating purposes,” the panel considered the LBP and sacroiliac dysfunction together for fitness and rating determinations.  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/or muscle spasm or guarding severe enough to result in an abnormal gait or spinal contour as reported on the NARSUM and VA examination proximate to separation.  

BOARD FINDINGS:  In the matter of the LBP with sciatica condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  There are 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 20150603, w/atchs
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

Dear XXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2015-00744.

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