RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX 	CASE:  PD-2015-01601
BRANCH OF SERVICE:  AIR FORCE 	SEPARATION DATE:  20040503

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Special Vehicle Fire Truck Maintenance, medically separated for “chronic lower back pain,” with a disability rating of 10%.

CI CONTENTION:  “Review all conditions.”  The 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 conditions 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 - 20040304	VARD - 20050405	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Lower Back Pain	5242	10%	Degenerative Disc Disease	5237	10%	20040818	
Mild Obesity	Cat III	No VA Placement	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Chronic Lower Back Pain.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s back condition began in May 2003 following an injury at work.  Magnetic resonance imaging (MRI) studies showed multi-level degenerative disc disease (DDD) without nerve root impingement.  Neurosurgery determined that the CI was not a surgical candidate.  At the physical medicine clinic appointment on 20 August 2003, the range of motion (ROM) was limited by pain in all planes.  The neurological examination was normal.  Despite treatment, including steroid injections, 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.  Repeat X-rays of the lumbar spine on 26 December 2003, following a car accident, showed no acute changes.  This was also the case for a CT of the lumbar spine on 9 January 2004.  The MEB NARSUM examination was undated, but on/after December 2003.  It documented noted complaints of low back pain.  The physical examination showed normal reflexes and strength.  Paraspinal tenderness was present to deep palpation of the para-lumbar muscles.  

At the VA Compensation and Pension (C&P) evaluation performed on 18 August 2004, 4 months after separation, the CI reported complaints of low back pain with occasional radiation into the right calf with numbness.  The physical examination showed a normal gait and neurological examination.  Provocative testing for radiculopathy was negative.  Atrophy was absent.  Range of motion showed a flexion of 80 degrees (normal 90) and a combined ROM of 210 degrees (normal 240).  The CI was able to toe to heel walk without difficulty.  The examiner noted that X-ray studies of the lumbar spine were negative (normal).  Her weight was 156 pounds, 3 pounds less than recorded at accession.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, coded 5242 (degenerative arthritis of the spine), associated with degenerative disk disease.  The VA also rated the back condition 10% coded 5237 (lumbosacral strain), based on the C&P examination 4 months after separation, citing limitation of forward flexion.  The panel agreed that a 10% rating, but no higher, was justified for limitation of flexion to 85 degrees and/or total combined ROM of 210 degrees as recorded on the VA examination proximate to separation.  Neither the gait nor the spinal contour were recorded as abnormal due to spasm or guarding and incapacitation was not documented.  The panel also considered if additional disability rating was justified for peripheral nerve impairment due to radiculopathy.  While the CI reported 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).”  The neurological examination was consistently recorded as normal.  There was no objective evidence of an unfitting radiculopathy at separation and an additional disability rating was not supported.  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 back condition.  

Contended PEB Condition:  Mild Obesity.  The panel notes that IAW DoDI 1332.38, Enclosure 5, subparagraph E5.1.3.10, Obesity is a condition not constituting a physical disability.  Therefore no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the chronic lower back pain condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the contended mild obesity condition, the panel unanimously recommends no change from the PEB determination as not unfitting and not compensable.  There were no other conditions within the panel’s scope of review for consideration.  The panel, therefore, recommends that there be no modification or re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150602, w/attachments
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-2015-01601.

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