RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02519
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20040910

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

CI CONTENTION:  “The VA gave me a rating of 50%, 40% of which I receive compensation for.  The Air Force should have given me the same percentage rating.”  The CI’s complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The Board’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 Board’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 Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’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 Board 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 Board 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 - 20040504	VARD - 20050602	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5237	10%	Degenerative Joint Disease of the Lumbar Spine	5243-5242	10%	20050507	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

Chronic Low Back Pain (LBP).  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s back condition began in 2001 without any specific injury or trauma.  

Magnetic resonance imaging (MRI) studies in January 2003 showed L2-L3 and L5-S1 initial degenerative disc disease (DDD) without herniated discs or disc bulging.  Electrodiagnostic (EMG) studies in October 2003 showed mild left L4 radiculopathy and possible very mild L5 radiculopathy. Radiographic (X-ray) studies in December 2003 showed mild degenerative changes at L2-L3, and an MRI showed wide radius left paramedian minimal disc bulging to L5-S1.  There was no surgical indication, and conservative treatment did not result in improvement sufficient to allow unrestricted duty. The MEB forwarded “lumbago” for PEB adjudication.

During the 3 March 2004 MEB NARSUM examination, 6 months prior to separation, the CI reported a 3-year history of LBP, with bending and lifting heavy objects.  He has left lateral thigh numbness and occasional sharp shooting pain down his left leg.  Physical examination showed no spinal tenderness, negative straight leg raise test for radiculopathy, normal strength, and decreased reflexes with left lateral thigh numbness.  There was no range of motion (ROM) measurement in evidence in the STR.  

At the 7 May 2005 VA Compensation and Pension (C&P) evaluation, 8 months after separation, the CI reported LBP with no injury and no surgery.  He reported two incapacitation episodes in the last year, and he experienced pain approximately one to two times a month.  The CI also reported that he avoids heavy lifting as this triggers his pain.  Physical examination showed normal posture and gait.  ROM measurements showed a flexion of 80 degrees (normal 90), a combined ROM of 230 degrees (normal 240), and no change with repetitive motion.  Sensation was intact to light touch throughout and motor strength was normal.  X-rays showed mild narrowing of the L2 and L5 disc spaces.  The CI was diagnosed with degenerative joint disease of the lumbar spine causing LBP.    
 
The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the LBP condition 10%, coded 5237 (lumbosacral strain), citing secondary to DDD.  The VA also rated the LBP condition 10%, coded 5243-5242 (degenerative arthritis of the spine-intervertebral disc disease), based on the C&P examination 8 months after separation, citing physical findings and incapacitating episodes having a total duration of at least one week but less than 2 weeks during the past 12 months.  

The Board agreed that a 10% rating, but no higher, was justified for limitation of flexion (greater than 60 degrees but not greater than 85 degrees) and combined ROM (greater than 120 degrees but not greater than 235 degrees) as reported on the VA examination. 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 documentation of intervertebral disc syndrome (IVDS) with incapacitating episodes in the service treatment records which would provide for a higher rating under that formula, nor evidence of ratable peripheral nerve impairment which would provide for additional rating.  

The Board also considered if additional disability rating was justified for peripheral nerve impairment due to radiculopathy.  The presence of functional impairment with a direct impact on fitness is the key determinant in the Board’s decision to recommend any condition for rating as additionally unfitting.  While the CI may have suffered additional pain from the nerve involvement, this is subsumed under the general spine rating criteria, which specifically states “with or without symptoms such as pain (whether or not it radiates).”  Therefore the critical decision is whether or not there was a significant motor weakness which would impact military occupation-specific activities.  There was no evidence in this case that motor weakness existed to any degree that could be described as functionally impairing.  The Board 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 Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the chronic LBP condition.   

BOARD FINDINGS:  In the matter of the chronic LBP condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration.  The Board, 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 20151104, w/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-2015-02519.

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