RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02299
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20070810

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Vehicle Maintainer, medically separated for “chronic low back pain status-post microdiskectomy L5-S1” with a disability rating of 20%.

CI CONTENTION:  The CI was given a higher rating by the VA.  The 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 - 20070418	VARD - 20071105	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain S/P Microdiskectomy L5-S1	5243	20%	S/P Microdiskectomy	5243	20%	20071022	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain S/P Microdiskectomy L5-S1.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s low back condition began in early December 2005 after lifting a starter out of a vehicle at work.  Two weeks after his initial injury he complained of severe pain with tingling in the right lower extremity (RLE).  Magnetic resonance imaging of the lumbar spine in February 2006 MRI showed he had a disc herniation on the right at L5-S1.  Evaluation by orthopedics and neurosurgery confirmed that he had a disc herniation on the right side at L5-S1 characterized as “large” and “partially extruded.”  Lumbar microdiskectomy surgery was performed in March 2006.  The CI initially did well after the surgery with resolution of pain and weakness of the right foot.  
At approximately 3 months after surgery he developed increased low back pain (LBP) with recurrent right lower extremity (LE) pain.  Repeat lumbar magnetic resonance imaging did not show a recurrent or persistent disc herniation and no further surgery was recommended at the time.  The CI received multiple injections without significant improvement.  

The 5 December 2006 MEB NARSUM examination, 9 months prior to separation, noted complaints of chronic LBP since December 2005.  The CI reported that he had a period of improvement following his back surgery but the pain returned and it radiated down his right LE.  He denied LE weakness or numbness.  Physical examination showed a normal gait.  Back ROM was flexion 45 degrees and combined ROM 170 degrees.  There was pain on straight leg raise (SLR) at 15 degrees on the right side.  Lower extremity deep tendon reflexes were 2+ bilaterally.  There was no weakness or foot drop.  

At the 22 October 2007 VA Compensation and Pension (C&P) evaluation, 2 months after separation, the CI reported LBP that radiated to the right LE.  He reported soreness and weakness of the low back and right thigh in the morning that caused no functional impairment because it resolved as the day progressed.  The physical examination showed an antalgic gait.  There was no muscle spasm, muscle atrophy, tenderness or ankylosis.  He did have a positive SLR and back flexion caused radiating pain to the RLE.  Thoracolumbar ROM was flexion 40 degrees and combined ROM 190 degrees and there was no additional pain, fatigue, incoordination or other symptoms upon repetition.  Right quadriceps muscle strength was reported as 3, without specification of the scale.  All other muscle strength was normal.  Sensation and reflexes were normal.  Repeat MRI on 19 October 2007 showed no change from a previous post-operative MRI.  

The panel directed attention to its rating recommendation based on the above evidence.  The Formal PEB rated the chronic low back condition 20%, coded 5243 (intervertebral disc syndrome), citing limitation of motion.  The VA also rated the chronic low back condition 20% coded 5243 (intervertebral disc syndrome), based on the VA C&P examination 2 months after separation, citing (limitation of forward flexion).  The VA also assigned a 10% rating for right sciatica coded 8620 (sciatic neuritis).  

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 MEB NARSUM and VA examinations.  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 the alternate VASRD formula (for IVDS).  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.  

BOARD FINDINGS:  In the matter of the chronic 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 modifications or re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150827, 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-2015-02299.

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