RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01288
BRANCH OF SERVICE:  Air Force	SEPARATION DATE:  20060603

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Aircraft Armament Systems Craftsman, medically separated for “low back pain due to degenerative disc disease with radiculopathy” with a disability rating of 10%.

CI CONTENTION:  Back condition warrants retirement.  The 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 confined to 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 - 20060814	VA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Low Back Pain due to Degenerative Disc Disease with Radiculopathy	5243	10%	No VA Disability Claim Filed	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  N/A	

ANALYSIS SUMMARY:  

Low Back Pain due to Degenerative Disc Disease (DDD) with Radiculopathy.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent back surgery (laminectomy with nerve root decompression at L5-S1 vertebral level) in April 2005 for DDD.  Following surgery further treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “chronic lower back pain and DDD” for PEB adjudication.  At the family practice clinic appointment on 13 December 2005 (10 months pre-separation), the CI reported back pain and right lower extremity numbness.  On physical examination, flexion was to 70 degrees (normal 90) with a total combined range of motion (ROM) of 200 degrees (normal 240).  Painful motion, gait, and spasm were not addressed.  At the physical therapy clinic appointment on 15 December 2005, the CI reported right upper back pain.  On physical examination the CI had “pain free spinal mobility” with flexion to the mid tibia [shin], “…marked improvement with straight leg raise, but still painful at end ROM,” and bilateral pain with nerve tension testing.  There was normal strength.

At the MEB NARSUM examination on 27 January 2006 (8 months pre-separation), the CI reported improved back pain, intermittent radiation to the right lower extremity, and persistent right lateral foot numbness.  Pain was provoked by lifting greater than 25 pounds, prolonged sitting and standing, heavy pushing and pulling, or heavy overhead work.  Physical examination showed lumbar spine tenderness, reflexes were normal, and there was reduced sensation in the right lower extremity.  The ROM was flexion to 70 degrees; painful motion was not addressed.  At the neurosurgery clinic appointment on 12 May 2006 (5 months pre-separation), the CI reported right leg residual numbness and normal strength.  Physical examination revealed normal strength and the ability to toe and heel walk.  There was no evidence of abnormal spinal contour or muscle spasm.  The ROM was fingertips to the knees (flexion); painful motion was not addressed.  The CI did not file a VA disability claim; and therefore, there was no VA Compensation and Pension evaluation for Board review.

The Board directed attention to the rating recommendation based on the above evidence.  The PEB rated the back condition 10% coded 5243 (intervertebral disc syndrome).  The Board agreed that a 20% rating, but no higher, was justified for limitation of flexion to 60 degrees.  The Board determined the December 2005 physical therapy (finger tips to mid tibia) and May 2006 neurosurgery (finger tips to knees) were reasonably indicative of 60 degrees flexion measurements.  Additionally, although the CI had intervertebral disc disease there were no incapacitating episodes requiring physician-prescribed bed rest to warrant consideration of rating under this alternate VASRD formula for intervertebral disc syndrome.  The Board also considered if additional disability rating was justified for peripheral nerve impairment due to radiculopathy.  The CI reported numbness and radiating pain to his right leg.  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 for a radiculopathy.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 20% for the low back condition coded 5237 (lumbosacral strain).

BOARD FINDINGS:  In the matter of the lumbar degenerative disc disease with radiculopathy condition, the Board unanimously recommends a disability rating of 20%, coded 5237 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.  

The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of her prior medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	
Lumbar Degenerative Disc Disease with Radiculopathy	5237	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150610, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAF/MRB

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Dear Mr. XXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2015-01288.

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 not appropriate under the guidelines of the Veterans Affairs Schedule for Rating Disabilities.  Accordingly, the Board recommended modification of your assigned disability rating without re-characterization of your separation with severance pay. 

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding, accept their recommendation and direct that your records be corrected as set forth in the attached copy of a Memorandum for the Chief of Staff, United States Air Force.  The office responsible for making the correction will inform you when your records have been changed.

Attachment:
1.  Directive 
2.  Record of Proceedings 

cc:
SAF/MRBR