RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02009
BRANCH OF SERVICE:  Air Force	SEPARATION DATE:  20050319

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

CI CONTENTION:  The CI requested a review of 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 - 20050131	VARD - 20051130	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain…	5238	10%	Mechanical Back Pain	5299-5238	10%	20051003	
Congenital Spinal Stenosis	Category III					
Obesity	Category III	No VA Placement	
Pain Disorder	Not Adjudicated	Pain Disorder	9422	NSC	20051005	
Undifferentiated Somatoform Disorder	Not Adjudicated	Adjustment Disorder	9440	NSC	20051005	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:

Chronic Low Back Pain.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s low back pain condition began in May 2003 without traumatic onset or injury.  Diagnostic imaging (MRI) in August 2003 showed congenitally short pedicles which caused a moderate degree of spinal stenosis but was thought not to be the source of the CI’s back pain.  Radiographic imaging (X-rays) in February 2004 were normal.  The CI was treated with physical therapy, chiropractic adjustments, osteopathic manipulations, and medications.  There was no surgical indication.  The CI’s low back pain condition could not be adequately rehabilitated to allow for unrestricted activity and the MEB forwarded “chronic low back pain” for PEB adjudication.  

The 12 August 2004 MEB NARSUM examination, 7 months prior to separation, noted complaints of constant back pain which worsened with repetitive standing, sitting and bending.  She occasionally played half-court basketball with chiropractic-manipulation therapy.  Physical examination showed a gait within normal limits.  Straight leg raises was positive for pain.  Range of motion (ROM) was 70 degrees flexion (normal 90); painful motion was not addressed.  

At the 3 October 2005 VA Compensation and Pension (C&P) Spine evaluation, performed 7 months after separation, the CI reported chronic low back pain without flare ups but occasional pain radiating to left buttock.  The CI reported that she did not miss work due to her back.  Physical examination showed a normal gait and could easily heel and toe walk.  ROM was 80 degrees forward flexion (normal 90), bilateral rotation 30 degrees each (normal 30), bilateral side bending 30 degrees each (normal 30) with combined ROM of 230 degrees (normal 240) with painful motion.  No additional loss of ROM, pain, weakness, incoordination or lack of endurance due to repetition.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back pain condition 10%, coded 5238 (spinal stenosis).  The VA also rated the low back pain condition 10%, analogously coded as 5238 (spinal stenosis), based on the VA C&P examination 7 months after separation citing loss of range of motion.  

The panel agree there was sufficient limitation of motion to support a minimum rating of 10% but no more under the General Rating Formula for Diseases and Injuries of the Spine.  There was no muscle spasm or guarding severe enough to result in an abnormal gait or spinal contour, thus the next higher 20% rating was not justified on this basis.  There was no evidence of intervertebral disc syndrome with incapacitating episodes which would provide for a higher rating under that formula.  

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 chronic low back pain condition.

Contended PEB Conditions:  Congenital Spinal Stenosis; Obesity; Pain Disorder And Undifferentiated Somatoform Disorder.  The Board considered if additional disability rating was justified for peripheral nerve impairment due to the CI’s diagnosed of spinal stenosis (Category III) and reported bilateral lower extremity paresthesias.  The panel requires a functional impairment linked to fitness to support a recommendation for addition of a peripheral nerve rating to service disability in spine cases.  The pain component of a radiculopathy is subsumed under the general spine rating as specified in §4.71a.  The MEB NARSUM and VA C&P examinations both documented the CI without subjective or objective evidence of lower extremity motor weakness or sensory deficits.  Therefore, the panel determined the CI’s previous history of lower extremity paresthesia did not significantly interfered with satisfactory duty performance at separation and could not be recommended for additional disability rating.  

Regarding the not unfitting contended obesity condition, IAW DoDI 1332.38, it does not constitute a physical disability.  Therefore, the panel has no basis for recommending it as unfitting.

The pain disorder and undifferentiated somatoform disorder, were forwarded by the MEB, but were not specifically adjudicated per the PEB’s AF Form 356; but, the Board judged that this was likely an erroneous omission to be assumed to constitute a de facto PEB determination that the conditions were not unfitting (Category III).  

After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for contended conditions and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the chronic low back pain condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the contended congenital spinal stenosis, obesity conditions, pain disorder and undifferentiated somatoform disorder, the panel unanimously recommends no change from the PEB determinations as not unfitting.  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 20150715, w/atchs
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-2015-02009.

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.  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 and I accept their recommendation that your application be denied.

Sincerely,

XXXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings