RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01589
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20080129

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Aviation Resource Management Journeyman, medically separated for “degenerative disc disease [DDD], status-post [s/p] L4-5 discectomy” with a disability rating of 10%.  

CI CONTENTION:  “My degenerative disc disease has had a huge impact on my cervical spine as well.  Since my separation I’ve had a major back surgery.”  The CI also requested review of additional conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB).  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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the MEB, but determined by the PEB 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.  The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence relevant to application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards for 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, which operates 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 disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20071212	VARD - 20080910	
Condition	Code	Rating	Condition	Code	Rating	Exam	
DDD S/P L4-5 Discectomy	5243	10%	DDD of the Lumbar Spine, S/P Discectomy L4-L5, with Recurrent Sciatica Bilateral Lower Extremities	5242	10%	20080515	
Cervical Pain	Cat II	Cervical Neck strain	5237	10%	20080515	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

DDD S/P L4-5 Discectomy.  According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent back surgery with discectomy in February 2005 for a herniated disc. Pain returned in 2006 and neurosurgery recommended physical therapy and reduction of activity but no surgical intervention.  

The 23 August 2007 MEB NARSUM examination, 5 months prior to separation, noted complaints of pain after sitting or standing longer than one hour.  She could perform her daily job in the office, but managed her pain by limiting activity and taking Motrin and Tylenol.  She continued home physical therapy and reduced all vigorous activity.  Physical examination showed normal gait, 5/5 strength in bilateral lower extremities, and pain with palpation over the entire lumbar spine.  She could not perform full range of motion (ROM) due to pain.   

At the 15 May 2008 VA Compensation and Pension (C&P) examination, 4 months after separation, the CI reported radicular symptoms down the right leg and some down the left leg with recurrent pain and tingling.  At times her right leg gave out suddenly while walking but she did not fall.  She reported that symptoms had increased especially in the right leg, tingling in the left leg, and flare-ups with activity.  Symptoms increased with prolonged sitting and walking but she walked 2 miles a day, frequently carrying her child.  She reported no incapacitating episodes in the past 12 months.  Physical examination showed normal gait and posture, flexion to 70 degrees (normal 90) with pain and extension was 10-15 degrees.  Repetitive motion did not change ROM.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back condition 10%, coded 5243 (intervertebral disc syndrome [IVDS]).  The VA rated the low back condition 10%, coded 5242 (degenerative arthritis of the spine), based on the C&P examination, citing limitation of forward flexion.  

The panel 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/or combined ROM (greater than 120 degrees but not greater than 235 degrees), as reported on the MEB NARSUM 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 evidence of IVDS which resulted in incapacitating episodes requiring physician-prescribed bed rest to warrant consideration of rating under the alternate VASRD formula for that condition.  The panel concluded there was no evidence to support a rating higher than that adjudicated by the PEB.  After due deliberation, considering all 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 DDD S/P L4-5 discectomy condition.  

Contended Condition:  Cervical Pain.  The panel’s main charge is to assess the fairness of the PEB’s determination that the Category II contended condition (can be unfitting but is not currently compensable or ratable) was not unfitting.  The condition was not profiled, implicated in the commander’s statement or judged to fail retention standards.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition, so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the DDD S/P L4-5 discectomy condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended cervical pain condition, the panel agrees it cannot recommend it for additional disability rating.  There are no other conditions within the panel’s scope of review for consideration.  Therefore, the panel recommends 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 20170228, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record  

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD 20762

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-01589.

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,

								XXXXXXXXXXXXXXXXXX
								Director
								Air Force Review Boards Agency

Attachment:
Record of Proceedings