RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME: XXXXXXXXXXXXXXXXXXX

CASE: PD-2017-05309

BRANCH OF SERVICE: AIR FORCE	SEPARATION DATE: 20061010

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (Cl) was an active duty E4, Pavements and Construction Equipment Journeyman, medically separated for "low back pain with radiculopathy" with a disability rating of 10%.

Cl CONTENTION:  No specific contention was made. 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 Cl, 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 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 • 20060803	VARD • 20070611	
Condition	Code	Ratinl!	Condition	Code	Ratinl!	Exam	
Low Back Pain with Radiculopathy	5243	10%	Degenerative Disc Disease	5242	10%	20061128	
			Radiculopathy, Left Lower Extremitv...	8520	10%	20061128	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 30%	

ANALYSIS SUMMARY:
Low Back Pain (LBP) with Radiculopathy. According to the service treatment record and MEB narrative summary (NARSUM), the Cl's low back condition began in January 2005 after a motor vehicle accident. He hurt his back again in July 2005 during squadron physical fitness training, and an MRI showed L4-LS and L5-Sl degenerative disc disease and a suspect small left lateral/far lateral extruded disc at L5-Sl without clear evidence of nerve root impingement. Lumbar spine X-rays on 18 January 2006 were essentially normal, but an MRI on 31 January 2006 showed moderate left L5-Sl foraminal stenosis secondary to asymmetric broad-based disc bulge and focal annular tear. There was no central canal stenosis and no evidence of acute injury. At a primary care visit on 22 March 2006, 7 months prior to separation, the Cl reported LBP and numbness and tingling down the left leg. The provider noted left lower paraspinal tenderness and muscle spasm, and that thoracolumbar range of motion (ROM) was not full (not quantified); spinal curvature, strength and reflexes were normal. The neurology consultation on 21 April 2006 was for persistent back pain with intermittent numbness in a nondescript pattern in the left foot,

but no definite leg weakness. Physical examination showed a mildly antalgic gait and no motor, sensory, or reflex deficits. Electrodiagnostic testing showed a mild left L5 radiculopathy.

The 21 June 2006 MEB physical therapy ROM study, 4 months before separation, reported trunk flexion with the middle finger reaching to 16 inches from the floor (approximates 65-80 degrees of thoracolumbar flexion), right lateral flexion with the finger 24 inches from the floor, and left lateral flexion with the finger 23.5 inches from the floor. Right rotation was to 30 degrees (normal) and left rotation to 25 degrees. The MEB NARSUM examination, 2 days later, noted complaints of LBP with radiation, numbness and intermittent tingling down the left leg. Physical examination showed muscle spasm and tenderness over the left paraspinal muscles, but normal spinal curvature (gait not addressed). Knee and ankle reflexes were 2/4 bilaterally with intact lower extremity strength. Straight leg raise (SLR) testing was negative for the right leg, but positive with tingling down the left leg and into the fourth and fifth toes. There was decreased ROM in all directions due to pain.

At the 28 November 2006 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported constant left LBP, rated at 2/10, with daily flare-ups rated at 5/10. The pain was aggravated by standing or sitting longer than 15-20 minutes, and bending, with intermittent radiation down the left hip and lower leg and foot with activities. The examiner note normal posture, but a noticeable limp to the right as well as tenderness over the left lower lumbar paraspinal muscles. Flexion was to 80 degrees (normal 90) and combined ROM was 230 degrees (normal 240), with painful motion. Lasegue’s signs (for radiating symptoms) were present and SLR testing was positive on the left.  Sensation and reflexes were normal.

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 also rated the low back condition 10%, but coded 5242 (degenerative arthritis of the spine), based on the C&P examination, citing increased pain during repetitive movements. The VA additionally rated the left lower extremity radiculopathy 10%, coded 8520 (sciatic nerve, paralysis of), based on the STR, citing EMG testing which showed a mild left L5 radiculopathy with resulting numbness in the left leg. Panel members agreed that while there was no ROM limitation supporting a rating higher than a 10%, the preponderance of the examinations proximate to separation documented muscle spasm with an antalgic gait. The NARSUM did not address gait, and although the C&P examination noted an antalgic gait, it did not specifically address spasm, although guarding could be inferred from the remainder of the examination. The panel agreed that the highly probative neurologist’s examination in conjunction with the entirety of the record supported a 20% rating for “muscle spasm or guarding severe enough to result in an abnormal gait.” There was no evidence of IVDS which resulted in incapacitating episodes requiring physician prescribed bed rest to warrant consideration of a higher rating under that alternate formula. There was also 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).” The intermittent left lower extremity paresthesias and abnormal left leg EMG were noted, however, 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 the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 20% for the low back condition, coded 5243.

BOARD FINDINGS: In the matter of the low back condition, the panel recommends a disability rating of 20%, coded 5243 IAW VASRD §4.71a. There are no other conditions within the panel’s scope of review for consideration.

The panel recommends the Cl's prior determination be modified as follows, effective the date of medical separation:

CONDITION	VASRD CODE	PERMANENT RATING
Low Back Pain  with Radiculopathy	5243	20%

Dear XXXXXXXXXX:
Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-05309.
After careful consideration of your application and treatment records, the Physical Disability Board of Review detennined that the rating assigned at the time of final disposition of your disability evaluation system processing was not in accordance with the guidelines of the Veterans Affairs Schedule for Ratmg Disabilities. Accordingly, the Board recommended modification of your assigned disability rating without re-characterization of your separation with severance pay.
I have carefully reviewed the evidence of record and the recommendation of the Board. I concur with that fmding, accept the recommendation and direct that your records be conected as set fo1th in the attached copy of a Memorandum for the Chief of Staff, United States Air Force. This will not result in any change to your separation documents or the amount of severance pay you are entitled to. Disability severance pay is computed the same regardless of a rating of 0, 10 or 20 percent.