RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02428
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20061006

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Aircraft Armament Systems Journeyman, medically separated for “chronic low back pain” 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 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 - 20060613	VARD - 20070515	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5243	20%	Intervertebral Disc Syndrome, Lumbar Spine	5243	20%	20061220	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

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 chronic low back pain condition began in 2002, but had worsened in 2005 after heavy lifting and lead to a hospitalization.  An X-ray L-spines series performed on 4 February 2005 showed reversal of cervical lordosis may have been positional or related to paraspinal muscle spasm, also potentially within normal range.  No fracture or listhesis or other focal osseous or paravertebral osseous or soft tissue abnormality was seen.  Intervertebral disk spaces were well maintained, and there was no posterior element derangement.  A MRI performed the same day showed focal disk protrusion at L5-L1 with abutment of the right S1 nerve root within the lateral recess.  There was no surgical indication, and conservative treatment with physical therapy and epidural injections did not result in improvement sufficient to allow unrestricted duty.  At the 26 January 2006 physical therapy clinic appointment, 8 months prior to separation, the CI reported chronic low back pain (2/10) with 1 severe episode per year, each worse than the previous.  He also reported tenderness in the low back and soreness in the mid-back, some tingling bilaterally in the feet, but no severe pain.  On examination, cautious movement for ROM resulted in forward flexion of 60 degrees (normal 90) and combined ROM of 185 degrees (normal 240).  Gait was normal, but with decreased arm swing and trunk rotation.  Straight leg raises were negative, as was a FABER test.  Reflexes were normal as was sensation.  There was some tenderness at L4-L5.  At the 1 March 2006 orthopedic clinic appointment, 7 months prior to separation, the examiner recorded improvements by the CI to include statements of moving to a new non-lifting job with good results.  Pain was at a 1-2/10 with no significant pain for over 2 months, and there was no complaint of lower extremity weakness, numbness or tingling.  The CI was “quite content with his current level of health and lack of low back pain.”  On examination, the CI was non-tender in the lumbar spine, with no detectable paraspinal muscle spasm.  He was able to touch his toes, albeit slowly but completely, without significant discomfort.  Reflexes were normal:  2/4 at the Achilles and patella bilaterally, with 1 beat of clonus bilaterally.  There was normal strength in the lower extremities in all muscle groups and a negative straight leg raise bilaterally.  The 7/8 March 2006 MEB NARSUM examination, 7 months prior to separation, noted complaints of severe pain and muscle spasms in the lumbar area and inability to lift anything greater than 5-10 pounds.  Physical examination was normal except decreased lumbar ROM secondary to pain and tight lumbar-sacral area paraspinal muscles with negative Waddell signs.  Per direction from Air Force Physical Evaluation Board, the examination was further supplemented by a 4 May 2006 Orthopedic clinic measurement of ROMs showing recording forward flexion to 50 degrees (90 normal) and combined ROM of 125 degrees (240 normal).  At the 20 December 2006 VA Compensation and Pension (C&P) evaluation, performed 2 months after separation, the CI reported low back pain (levels from 2-10 on scale of 10) 5 times per day, each lasting for 2 hours.  The pain could be elicited by physical activity and stress; and was relieved by rest and hot tub, generally without medication.  At times he needed bed rest to relieve the pain, with incapacitating episodes as often as once a year, lasting for 14 days; he stated there were no episodes over the previous year.  Additionally, the CI related difficulty with daily activities of living and inability to participate in recreational activities.  There is also stiffness, worsening with activity, but not causing incapacitation.  Physical examination showed a well-developed, well-nourished individual in no acute distress.  ROMs were forward flexion at 50 degrees (90 normal) and 150 combined (240 normal) after repetition, limited by pain, fatigue and weakness.  There was no tenderness to palpation.  Spasms were present on the right para spinal muscles, but gait and spinal contour were within normal limits.  There were signs of intervertebral disk syndrome with subjective pain radiation to the legs, but no bowel, bladder or erectile dysfunction.  Straight leg raise was negative on both sides and there was no evidence of radiating pain on movement.  There was decreased strength in the left leg.  Lastly, x-ray was within normal limits.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the “chronic low back pain” condition 20%, coded 5243 (intervertebral disc syndrome), citing limitation of motion.  The VA also rated the “intervertebral disc syndrome, lumbar spine” 20% coded 5243 (intervertebral disc syndrome), based on the VA C&P examination 2 months after separation, citing objective findings of limitation of motion, painful motion and other related findings.  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).  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).  The evidence showed the CI had IVDS (disc disease causing back pain and sciatica) and experienced incapacitating episodes due to acute signs and symptoms that required treatment and bed rest prescribed by a physician, but there was no documentation of physician-prescribed treatment and bedrest within the 12 months prior to separation.  Additionally, at his VA C&P examination, the CI stated that he averaged only a single incapacitating episode per year, and he had not had an episode within the last year.  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 pain 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 re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20151003, 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-2015-02428.

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 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.  I accept their recommendation that your application be denied.

Sincerely,

XXXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings