RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02542
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20051116

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Heating, Vent, A/C & Refrigerating Journeyman, medically separated for “low back pain with small herniated nucleus pulposus, L5-S1” with a disability rating of 10%.  

CI CONTENTION:  The CI made specific contention for pain and leg/foot numbness, paresthesias left arm and leg, sleep apnea, and back pain.  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 - 20050830	VARD - 20061113	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Low Back Pain with Small Herniated Nucleus Pulposus, L5-S1	5243	10%	Degenerative Disc Disease Lumbar Spine with Disc Bulge L3-L5 and Herniated Nucleus Pulposus L5-S1	5242	10%	20060710	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Low Back Pain (LBP) with Small Herniated Nucleus Pulposus (HNP), L5-S1.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s LBP condition began in 2000 without any specific injury or trauma.  Magnetic resonance imaging (MRI) studies showed central disc protrusion at L4-5 and L5-S1.  According to the neurosurgeon the CI was not a surgical candidate.  

The 6 August 2005 MEB NARSUM examination, 3 months prior to separation, noted complaints of back pain.  The physical examination showed tenderness to palpation of the low back paraspinous muscles and normal gait.  

At the 10 July 2006 VA Compensation and Pension (C&P) evaluation, 8 months after separation, the CI reported constant low/mid back pain 2-6/10 and low back stiffness.  He denied any absence from work in the previous 12 months or any incapacitating episodes.  The physical examination showed normal posture, normal gait and no muscle spasm.  Range of motion (ROM) showed a normal forward flexion of 90 degrees and a normal combined ROM of 240 degrees, all ROM measurements were without pain.  Repetitive motion testing increased the CI’s subjective complaints of pain but did not change the ROM or joint fatigability.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the LBP condition 10%, coded 5243 (intervertebral disc syndrome).  The VA rated the LBP condition 10% coded 5242 (degenerative arthritis of the spine), based on the VA C&P examination 8 months after separation, citing evidence showing degenerative disc disease and painful motion after repetition.  

Although there was insufficient limitation of motion to support a minimum rating, the panel agreed a 10% rating was justified for the presence of painful motion and tenderness.  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 (IVDS) with incapacitating episodes for an additional rating under that formula.  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).”  

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 low back pain condition.  

BOARD FINDINGS:  In the matter of the LBP 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 20151118, 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-2015-02542.

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