RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01110
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20030926

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Air Transportation, medically separated for “chronic low back pain and radiculopathy status post laminectomy,” with a disability rating of 20%.

CI CONTENTION:  “Review all conditions” 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 - 20030812	VARD - 20040318	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain and Radiculopathy S/P Laminectomy	5295	20%	Degenerative Disc Disease, Lumbar Spine S/P Lumbar Laminectomy at L5-S1 with Residual Scarring and Radiculopathy	8620-5243	10%	20031016	
Obesity	Cat III	No VA Entry	
COMBINED RATING: 20%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain…and Radiculopathy.   According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent back surgery with discectomy and laminectomy in September 2002 for a herniated disc.  Following surgery further treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “chronic low back pain degenerative disc disease ABD status post lumbar laminectomy” for PEB adjudication.  

The initial MEB NARSUM on 11 March 2003, 6 months post-surgery and 6 months prior to separation noted the CI’s back pain limited his ability to exercise.  Physical examination showed adenopathy (glandular enlargement) on the left lower extremity with reduced deep tendon reflexes on the left side (1+ vs. 2+ on the right).  The CI was unable to toe walk on his left leg.  At the Family Practice (FP) examination on 13 March 2003, 6 months post-surgery and 6 months prior to separation, the CI complained of left lower extremity weakness with limping.  The CI had no bowel or bladder dysfunction.  Physical examination showed the CI walked with a slight limp.  Neurologic examination was essentially normal.  The examiner noted muscle atrophy of the left leg and that the CI could not toe walk and had a positive left straight leg raise at 45 degrees.  The Neurosurgery examination on 24 March 2003, 6 months post-surgery and 6 months prior to separation, noted the complaints of left foot pain which was non-radicular in nature.  Physical examination had normal straight leg raise.  The examiner surmised the pain was most compatible with Morton’s neuroma and clearly did not appear radicular in nature.  Physical examination documented no motor or sensory deficits in the lower extremities.  The MEB NARSUM addendum on 12 May 2003, 8 months post-surgery and 4 months prior to separation noted the CI’s back pain prevented him from performing high impact aerobic exercises but he could ride a stationary bike.  Physical examination recorded muscle atrophy of the CI’s left calf (1/2 inch less than right calf).  Deep tendon reflexes on the left were 1+ (vs. the right which were 2+) and he had a positive left straight leg raise.  Neurologic sensation was intact.  The CI was unable to toe walk on the left leg.  Back range of motion (ROM) was reduced to flexion and rotation.  There was no scoliosis observed.  

At the 16 October 2003 VA Compensation and Pension (C&P) general medical evaluation, performed 3 weeks after separation, the CI reported  that since his back surgery in September 2002, he experienced recurrent low back pain which was not as serious as before surgery, and his leg symptoms had almost completely resolved.  He was doing strengthening exercises for his left leg, with good results.  Prior left leg numbness was greatly improved and felt essentially normal.  The CI could engage in most activities however he experienced pain with lengthy sitting (>2 hours).  He could lift a moderate amount of weight without pain.  Physical examination showed the CI with a normal gait and posture.  ROM measurements recorded 80 degrees of forward flexion (normal = 90) and 215 degrees combined (normal = 240).  Pain was documented at the extreme of extension.  He had normal left and right leg reflexes.  His lower extremities major muscle groups were judged to be normal and equal.  Straight leg testing was normal in both sitting and supine position with complaint of low back pain at about 60 degrees of elevation of the left leg only.  The CI was neurovascularly intact.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic low back pain and radiculopathy condition 20%, coded 5295 (lumbosacral strain, with muscle spasm on extreme forward bending, loss of lateral spine motion, unilateral, in standing position).  The PEB also found obesity as a Category III condition, not separately unfitting, compensable or ratable.  The VA rated the chronic low back pain and radiculopathy condition 10%, analogously coded 8620-5243 (intervertebral disc syndrome), based on the VA C&P examination 3 weeks after separation, citing forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; or, muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or, vertebral body fracture with loss of 50 percent or more of the height; or, incapacitating episodes having a total duration of at least 2 weeks but less than 4 weeks during the past 12 months.  The Board concluded there was no evidence to support a rating higher than the rating adjudicated by the PEB.  The Board found the VA C&P examination 3 weeks after separation to be most probative as it was the closest examination to separation, it was the most thorough and it was the most VASRD compliant.  The Board also considered if additional disability rating was justified for peripheral nerve impairment due to radiculopathy.  The CI had a herniated disc with radicular pain treated with surgery, and there were symptoms of radiating pain documented in the treatment records; however, examinations proximate to separation indicated normal strength, reflexes and gait, and the sensory changes did not affect his job.  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.  While the CI may have suffered additional pain from the nerve involvement, this is subsumed under the general spine rating criteria, which specifically states “with or without symptoms such as pain (whether or not it radiates).”  Therefore 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.  The Board therefore concluded that an additional disability rating was not justified on this basis.  Finally, there was no evidence of intervertebral disc syndrome (IVDS) which resulted in incapacitating episodes requiring physician-prescribed bed rest to warrant consideration of rating under the alternate VASRD formula (for IVDS).  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 and radiculopathy condition.  

Contended PEB Conditions:  Obesity.  The Board’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting, not compensable or ratable (Category III).  Obesity is not a compensable condition under the regulations of the Department of Defense (DoDI 1332.38) Disability Evaluation System in effect at the time of the CI’s separation.  After due deliberation, the Board concluded that there was insufficient cause to recommend a change in the PEB determination for the contended obesity condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the chronic low back pain and radiculopathy condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended obesity condition, the Board unanimously recommends no change from the PEB determinations as not unfitting, not compensable and not ratable.  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 20150609, 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

XXXXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2015-01110.

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

Attachment:
Record of Proceedings