RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  pd-2016-00700
BRANCH OF SERVICE:  air force 	SEPARATION DATE:  20041115

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Tactical Aircraft Maintenance Journeyman, medically separated for “chronic low back pain secondary to degenerative disk disease” with a disability rating of 10%.  

CI CONTENTION:  Review of all conditions requested.  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 - 20040902	VARD - 20050615	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic LBP secondary to DDD	5243	10%	DDD of the Lumbar Spine with LBP	5243	20%	20050323	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain (LBP) secondary to Degenerative Disk Disease (DDD).  According to the service treatment record (STR) and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI injured his back in 1999 after hitting it on a door while working.  His back pain continued to worsen over time and traveled down his right leg.  Radiographic studies (CT) done in February 2004 showed a disc protrusion with a right paracentral component at L5-S1 with right neural foraminal encroachment.  There were no electro-diagnostic studies for review in the record.  The CI had been offered lumbar epidural injections, but declined that treatment option. There was no surgical indication, and conservative treatment did not result in improvement.  

The 24 June 2004 MEB NARSUM examination, 5 months prior to separation, noted complaints of recurrent LBP that “occasionally shoots down his right leg.”  Pain was aggravated with any amount of activity which made him unable to perform the usual duties as a crew chief due to the strenuous nature of that position.  Physical examination showed the CI had an antalgic gait with back tenderness.  There was “pain upon sitting and pushing out of the chair when arising.”  Motor strength, sensation, and reflexes were intact and bilaterally symmetric.  The examiner did not document thoracolumbar spine range of motion (ROM) measurements.  The examiner’s final assessment was that the CI had “lower back pain with radicular symptoms.”  

At the time of the 31 August 2004 pain management clinic appointment, 3 months prior to separation, the CI reported continued LBP and described his symptoms as improving.  Physical examination showed the CI had an antalgic gait and lumbar pain upon sitting.  There was no swelling present.  Motor strength for the lower extremities was 5/5.  Sensory was intact and bilaterally symmetrical and reflexes were normal.  The clinical assessment was LBP with DDD.  Multiple physical therapy notes proximate to separation indicated right sacroiliac tenderness and decreased LBP symptoms.  

At the 23 March 2005 VA Compensation and Pension (C&P) evaluation, 4 months after separation, the CI reported constant, dull LBP with flares and muscle spasms.  He also reported some numbness and tingling in his toes until his physical therapist “put him back into alignment.”  He reported symptoms were worse with prolonged sitting or when lifting more than 60 lbs.  Adjustments and hot baths provided relief to his symptoms.  He reported flare-ups approximately once every 3 weeks.  The increased pain during flare-ups made doing activities of daily living more difficult.  He was not required to use any assistive devices.  Physical examination showed the CI had normal posture, gait, and stance.  The back ROM measurements were painful forward flexion to 90 degrees (normal), with combined ROM of 230 degrees (normal 240).  The CI had tenderness over the paravertebral lumbar spine muscles.  Reflexes were normal, sharp/dull discrimination was intact, and muscle strength was normal in all extremities.  There was no weakness, incoordination, fatigability or further limitation in the ROM with repetitive ROM measurements.  X-rays of the spine were normal.  

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 [IVDS]), citing DoD and VASRD guidelines.  The VA rated the LBP condition 20% also coded 5243 (IVDS) based on the C&P examination 4 months after separation, citing 90 degrees of flexion with painful motion at 60 degrees of flexion; with “orthopedic manifestations” of the condition, stating that there were no neurological manifestations noted in his examination.  

The panel agreed a 10% rating, but no higher, was justified for combined ROM (greater than 120 degrees but not greater than 235 degrees), as reported on the C&P examination, or tenderness and painful motion as reported on the NARSUM and C&P examinations proximate to separation.  There was no documentation of IVDS with incapacitating episodes which would provide for a higher rating under that formula.  

The panel noted the PEB rendered a de facto “not unfitting” determination by not explicitly addressing the MEB’s submission of radiculopathy (“lumbar radiculopathy”) and the CI contended this condition.  Radiculopathy is therefore in the panel’s scope of review and will be addressed.  There was no associated radiculopathy for separate peripheral nerve rating.  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).”  There was no objective evidence of a radiculopathy with functional impairment (such as weakness) that directly impacted fitness for duty.  The panel 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 panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the LBP 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 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 20160914, 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-2016-00700.

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,

Attachment:
Record of Proceedings