RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01525
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20070305

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Service Journeyman, medically separated for “low back pain,” with disability rating of 10%.

CI CONTENTION:  “Since I have been medically discharged from the military, my pain due to injuries was increased substantially.  I have a consistent numbness in my legs that shoot pain to my toes and pain in my neck resulting in reoccurring numbness.”  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 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 – 20061228	VARD – N/A	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain due to Degenerative Disc Disease	5243	10%	There was no VA examination within the 12 Month Period for Adjudication	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  N/A	

ANALYSIS SUMMARY:  

Low Back Condition.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the low back pain (LBP) condition began approximately 3 years prior to referral for MEB.  Radiographic studies (MRI) showed degenerative disc disease with bulging discs at L4-5 and L5-S1 with no central canal narrowing or neural foramina (nerve root) compromise, but the L5-S1 disc abutted the right S1 nerve root.  Despite treatment, the back condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for MEB.  
At a 28 July 2006 family practice encounter the CI complained of LBP, pain radiating to the legs and left groin, and left leg numbness.  He denied a history of back trauma, lower back muscle spasms, bilateral leg weakness, right leg numbness, perineal numbness, fecal incontinence, and urinary incontinence.  The physical examination documented a normal stance, posture, and gait.  The thoracic, thoracolumbar, lumbar, and lumbosacral spines had normal appearance with no paraspinal muscle spasms.  There was no thoracolumbar or lumbosacral spine tenderness.  There was pain with thoracolumbar and lumbosacral spine range of motion (ROM).  Thoracolumbar spine ROM was full.  The straight leg raise ([SLR] assesses for herniated disc causing sciatic nerve root [L5-S1] radiculopathy) tests were negative.  Strength, sensation, and deep tendon reflexes (DTRs) were normal and “No peripheral neuropathy was noted.”  

At the 22 August 2006 physical medicine encounter the CI reported 5-10/10 pain (back greater than leg) with a 1 year history of constant left leg numbness and tingling to the foot.  He denied fecal incontinence, urinary loss of control, and perineal numbness and tingling.  The physical examination documented a normal gait and stance.  The lumbosacral spine appeared normal with no muscle spasm.  There was left lower paraspinal tenderness with no lumbosacral spine, sacrum, or sciatic notch tenderness.  Pain-limited lumbosacral spine ROM lacked 25-50% of normal range in all planes.  No actual ROM measurements were given.  The hip examination revealed left piriformis muscle tenderness.  The SLR tests was positive on the left.  The bilateral Gillet (assess for abnormal movement of the sacroiliac joint), Patrick (assesses hip and sacroiliac joint pathology), Ober's (assesses tightness or inflammation of the iliotibial band), and piriformis (assesses for piriformis muscle compressing sciatic nerve) tests were negative.  Strength, DTRs, and sensation were normal except for “decreased response to tactile stimulation in the left L5 and S1 dermatomes.”  

In the 15 December 2006 MEB NARSUM, 3 months before separation, the CI reported a 3-year history of LBP and left leg numbness and weakness.  Back pain was exacerbated by prolonged sitting, prolonged standing, and sudden movement, lifting, flexing forward, and extending backwards.  With pain exacerbations/flare ups, he reported associated radiating pain to the legs (L>R), paresthesias (abnormal sensation, tingling, burning, prickling), and weakness.  He denied significant improvement with activity modification, physical therapy (PT), physical medicine, and medications (NSAIDs, narcotics, and muscle relaxants) and wore a back brace when carry items greater than 40 lbs.  “A MRI was done and showed disc bulges at level L4-5 and L5-S1 with nerve encroachment on L5 nerve root.”  The physical examination documented an antalgic (assuming a gait or posture to lessen pain) gait and a stance favoring the right foot.  The back examination revealed a normal appearance, no step-off, and palpable paraspinal muscle spasms.  There was left L5-S1 tenderness with no spinous process tenderness.  The pain-limited ROM values were flexion of 80 degrees (90 normal), extension of 10 degrees (30 normal), and bilateral lateral flexion of 10 degrees (30 normal).  The SLR test was positive on the left.  Strength was normal except for 4/5 left leg strength.  The examiner recounted the findings of the lumbar X-rays and MRI.  At the 1 November 2006 family practice encounter, the CI complained of mild, 2/10 low back pain and pressure following an L5 epidural steroid injection on the previous day.  He denied leg numbness or weakness and bowel or bladder incontinence.  The musculoskeletal examination revealed a puncture site over L5 with no tenderness, erythema (redness), or pus.  It documented “cannot flex L-spine beyond 80 degrees and states this is minimally less than his norm.”  There was no VA examination in evidence proximate to separation.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under the 5243 code (intervertebral disc syndrome) citing chronic low back pain due to degenerative disc disease.  While the physical medicine ROM values were consistent with the 20% rating (flexion of greater than 30 degrees but not greater than 60 degrees; or a combined ROM of not greater than 120 degrees of the thoracolumbar spine), the MEB NARSUM and family practice ROM values were consistent with the 10% rating (flexion of greater than 60 degrees but not greater than 85 degrees; or combined ROM of greater than 120 degrees but not greater than 235 degrees of the thoracolumbar spine).  Although, the MEB NARSUM documented muscle spasms and an antalgic gait, the family practice and physical medicine encounters documented no muscle spasm, abnormal gait, or abnormal spinal contour.  While the CI may have complained of pain radiating into the left leg, this is subsumed under the general spine rating criteria, which specifically states “with or without symptoms such as pain (whether or not it radiates).”  The critical decision is whether or not there was significant motor weakness which would impact military occupation specific activities.  There was no evidence that motor weakness or sensory loss existed to any degree that could be described as functionally impairing.  The panel therefore concluded that additional disability rating was not justified on this basis.  Other routes to a rating higher than the PEB’s 10% were considered, but there was no evidence of additional functional loss from repetitive use to warrant application of VASRD §4.45.  The panel agreed a 10% rating was supported based on limitation of flexion greater than 60 degrees but not greater than 85 degrees and/or combined ROM greater than 120 degrees but not greater than 235 degrees.  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 low 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 20150620, 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-2015-01525.

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
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings