RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02782
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20060801

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6, Services Craftsman, medically separated for “low back pain with radiculopathy” with a disability rating of 10%.  

CI CONTENTION:  “Had back surgery 2008 to fuse back due to condition.” 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 Medical Evaluation Board (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 - 20060614	VARD - 2071002	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Low Back Pain with Radiculopathy	5243	10%	Lower Back Degenerative Joint Disease	5237	10%	20061012	
			Left Lumbar Radiculopathy with +1 on Left Knee	8520	10%	20061012	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain (LBP) with Radiculopathy.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s LBP began towards the end of 1999 after being involved in a motor vehicle accident.  In 2002-2003 she began to experience pain that radiated down the back of both legs while occasionally radiating up her back.  In February 2004, an initial MEB retained her for further evaluation and treatment.  An MRI in October 2004 showed degenerative disc disease at L5-S1 without central canal stenosis or neuroforaminal narrowing.  Electrodiagnostic studies performed on 1 February 2005 included only the right lower extremity and were unremarkable except for evidence of a mild subacute or chronic process in the quadriceps muscles (L3-4 myotome).  A repeat MRI on 16 February 2006 showed no changes with no herniation or significant stenosis noted.  An evaluation by neurosurgery on 30 March 2006 determined the CI was not a surgical candidate. 

At the 26 April 2006 MEB NARSUM examination, 3 months prior to separation, the CI complained of almost daily LBP, rated at 9/10 most days, with radiation down both lower extremities to the knees along the L5-S1 dermatome.  She described her pain as constant, moderate, sharp and aching with no associated numbness or weakness.  Physical examination revealed mild lumbar tenderness and muscle spasm, but normal lower extremity strength and reflexes.  The provider referenced thoracolumbar (TL) range of motion (ROM) measurements by physical therapy on 27 March 2006, which showed flexion of 50 degrees (normal 90) and combined ROM of 165 degrees (normal 240), with limitation of motion caused by pain.

A pain medicine visit on 21 June 2006, 1 month before separation, noted CI complaints of continued LBP, rated at 5/10, that radiated to both lower extremities in an L5-S1 distribution.  A series of lumbar steroid epidural injections (ESIs) were planned, and at a pain medicine follow-up visit on 27 July 2006, the CI reported excellent improvement in her LBP after one injection.  She rated her pain at 1/10 and stated that she had been able to perform her daily activities with minimal discomfort for the first time in a long while; she was prescribed physical therapy.  

At the 12 October 2006 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported sharp LBP, rated at 6/10, and exacerbated by standing or walking more than an hour, or sitting for an hour.  It was improved by changing position as well as medications.  She reported that she had not had surgery and experienced flares approximately once a week precipitated by excessive activity and improved by medication.  During these flares she reported 50% decrease in her ROM and a 50% increase in stiffness in the morning with lasted 30 minutes to an hour.  She was able to walk a half a mile and used a cane during flares.  Physical examination showed a normal gait.  Thoracolumbar ROM was 75 degrees of flexion and combined ROM of 155 degrees.  Strength was normal in the bilateral lower extremities, and although left knee deep tendon reflex was absent, all other reflexes were otherwise symmetrical.  

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), citing that the rating was “IAW Department of Defense and Veterans Administration Schedule for Rating Disabilities guidelines.”  The VA also rated the low back condition 10%, coded 5237 (lumbar strain), based on the C&P examination, citing limitation of motion.  Members noted that although the MEB PT ROMs showed TL flexion of 50 degrees, which supports a 20% rating, the CI continued to be treated for the radiating LBP with an ESI and physical therapy.  At the pain medicine visit just days before separation, the CI reported excellent back pain relief from the recently performed ESI and minimal daily discomfort.  At the C&P examination 2 months later, TL flexion was 75 degrees which supports a 10% rating.  Based on the CI’s documented improvement proximate to separation, the panel majority placed greater probative value on the evidence at the C&P examination for its rating recommendation.  After due deliberation, considering all 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 condition. 

The panel next 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 panel’s decision to recommend any condition for rating as additionally unfitting.  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 also no objective evidence of 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.

BOARD FINDINGS:  In the matter of the chronic low back pain and IAW VASRD §4.71a, the panel majority recommends no change in the PEB adjudication.  The single voter for dissent recommends modification to 20% and did not elect to submit a minority opinion.  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 20170418, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-02782.

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