RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02001
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20070313

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Munitions Systems Journeyman, medically separated for “low back pain accompanied by occasional right sided sciatic with degenerative changes of L4-5 and L5-S1” with a disability rating of 20%.  

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 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 - 20070108	VARD - 20080909	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Low Back Pain Accompanied by Occasional Right Sided Sciatica with Degenerative Changes	5242	20%	Degenerative Disc Disease L4-5 and L5-S1	5242	20%	20080821	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Low Back Pain Accompanied by Occasional Right Sided Sciatica with Degenerative Changes.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s back symptoms began in April 2005 after slipping on a wet surface and landing on her back.  Physical therapy failed to produce any improvement in her symptoms.  An MRI in June 2005 showed minor degenerative changes at L4-5 and L5-S1.  An electrodiagnostic testing (EMG/NCS) completed in October 2005 was normal.  There was no surgical indication, and conservative treatment did not result in improvement sufficient to allow unrestricted duty.  

The 21 November 2006 MEB NARSUM examination, 4 months prior to separation, physical examination showed a normal appearance of the thoracic spine.  There were no spasms.  The lumbar spine exhibited tenderness to palpation of the paraspinal muscles.  Thoracolumbar range of motion (ROM) measurements showed flexion of 45 degrees (normal 90) and a combined ROM of 155 degrees (normal 240), with painful motion.  A straight leg raise test (for radicular symptoms) was positive on the right.  Gait and stance were normal.  Motor and strength were normal.  

At the 13 August 2008 VA Compensation and Pension (C&P) evaluation, performed 17 months after separation, the CI reported  constant low back pain that radiates to one or both legs.  The CI denied use of medications, ice or tropical analgesics.  Pain was rated at 5/10 which increased to 8/10 with weight bearing more than 2-3 hours.  The CI reported when the pain increased she took ibuprofen and stayed in bed until the pain improved.  She also reported she would require assistance and be carried to the bathroom because she was unable to walk.  The CI was never told by a provider she must stay in bed to treat back pain.  She was not using a brace or assistive device.  The examiner noted the CI was able to sit comfortably for greater than 1 hour and get on and off exam table without assistance.  Physical examination showed erect posture and no muscle spasms.  The CI reported pain and exhibited withdrawal and buckling knees with extremely light palpation of the spine.  Motor, reflexes and sensory testing were normal.  Straight leg raise testing was limited to 60 degrees by report of increased back pain, however she denied radicular symptoms.  The examiner noted the CI was “hesitant and put forth little effort to perform ROM” testing.  Flexion was recorded at 24 degrees on the first attempt and 10 degrees on the second attempt.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 20%, coded 5242 (degenerative arthritis of the spine).  The VA also rated the back condition 20% coded 5242, based on the VA C&P examination 17 months after separation, citing little effort to perform ROM trials, therefore less probative value was assigned and the PEB proceedings were deemed more reliable.  

The panel agreed that a 20% rating, but no higher, was justified for limitation of flexion (greater than 30 degrees but not greater than 60 degrees) reported on the NARSUM examination.  Although the limitation of thoracolumbar motion recorded at the C&P evaluation met the threshold for a 40% rating, the board agreed the probative value was judged to be compromised by poor effort and the remoteness (17 months) from the date of separation.  There was no documentation of intervertebral disc syndrome (IVDS) with incapacitating episodes which would provide for a higher rating under that formula (for IVDS).  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 low back condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  There are 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 20150716, with attachments
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

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2015-02001.

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,

XXXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings