RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01295
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20070625

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

CI CONTENTION:   The CI noted that his back pain required treatment and was associated with numbness and tingling radiating down his legs.  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 or non-compensable.  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 determination 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(s) 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 - 20070511	VARD - 20071012	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain with Paresthesias…	5243	20%	Lumbar Strain	5237	0%	20070829	
COMBINED RATING: 20%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:

Chronic Low Back Pain with Paresthesias.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s back condition began gradually in 2006.  The CI denied any specific injury or trauma.  Magnetic Resonance Imaging (MRI) in November 2006 showed early disc degeneration at L5-S1 with diffuse congenital lumbar narrowing (spinal stenosis), but no nerve root impingement.

At the time of a neurology clinic appointment on 1 November 2006, 8 months prior to separation, the CI reported that back pain was present mostly when sitting.  He denied lower extremity weakness, but noted numbness and pain in the right leg and lateral aspect of the foot.  Examination showed a normal gait.  Lower extremity strength was normal, but a sign of possible nerve root irritation was positive on the right and impaired sensation in the right S1 dermatome (posterior calf, lateral foot) was present.  A diagnosis of right S1 radiculopathy was rendered.  Lifting, bending, and stooping restrictions were applied.  At follow-up neurology evaluations in December 2006 and February 2007, back symptoms were described as intermittent with no weakness or sensory loss.

The MEB NARSUM examination on 22 March 2007, 3 months prior to separation, noted little functional limitations other than work restrictions.  The CI reported that he was usually pain-free except for lower back pain that occurred three times per week, which was caused by prolonged sitting or driving and associated with radiation into the buttock.  Physical examination showed a normal gait and no back tenderness or muscle spasms.  A test for possible nerve root irritation was positive on the right.  Neurological exam showed decreased sensation on the right lateral leg and foot.  Reflexes and muscle strength were normal.  Range of motion (ROM) measurements by physical therapy (PT) on 16 April 2007 (2 months prior to separation) showed lumbosacral flexion of 52 degrees (normal 90) and combined ROM of 190 degrees (normal 240).

At the 29 August 2007 VA Compensation and Pension (C&P) evaluation, 2 months after separation, the CI reported mild, daily, back pain with shooting pain to his lateral right thigh.  Flares were moderate, occurring weekly, last 1-2 days.  There was no limitation of walking imposed by the low back condition.  Physical examination showed no spasm, guarding, tenderness or painful motion.  Gait and spinal curves were normal.  Lower extremity neurologic findings were normal and a test for nerve root irritation was negative.  Thoracolumbar flexion was 90 degrees and combined ROM was 240 degrees.  Repetitive motion did not result in limitation of motion. 
 
The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back condition 20%, coded 5243 (intervertebral disc syndrome).  The VA rated the low back condition 0% coded 5237 (lumbosacral or cervical strain), based on the C&P examination 2 months after separation, citing a normal examination.  There was no limitation of motion in evidence which supported a rating higher than the PEB’s 20%.  The panel considered whether a higher rating (§4.7) was achieved by using the alternate rating formula based on incapacitating episodes due to intervertebral disc syndrome (IVDS).  Although the CI had intervertebral disc disease, there were no incapacitating episodes requiring physician-prescribed bed rest to warrant consideration of rating under that alternate VASRD formula.  The panel next considered if additional disability rating was justified for peripheral nerve impairment due to radiculopathy.  The CI variably reported intermittent paresthesias and numbness, especially to the right lower extremity.  However, examinations 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 panel’s decision to recommend any condition for rating as additionally unfitting.  While the CI may have experienced radiating pain from the back condition, this is subsumed under the general spine rating criteria, which specifically states “with or without symptoms such as pain (whether or not it radiates).”  There was no objective evidence of a radiculopathy with functional impairment (such as weakness) that directly impacted fitness for duty.  The panel therefore 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 panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the back condition.  

BOARD FINDINGS: In the matter of the back condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  There were 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 20150608, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAF/MRB
XXXXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2015-01295.

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