RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2017-05326
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20050601

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Operations Journeyman, medically separated for “post laminectomy syndrome with back pain” and “pain disorder, chronic,” rated 10% each, with a combined disability rating of 20%.   

CI CONTENTION:  “To review DOD disability rating assigned by the PEB to ensure accuracy and fairness.”  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 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 - 20050406	VARD – 20051107	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Post Laminectomy Syndrome with Back Pain	5243	10%	Chronic Back Pain due to Two Vertebrae Fusion	5241	NSC	STR	
Pain Disorder	9422	10%	No VA Placement	
Dysthymia	Cat II	Depression/Anger Management	9434	NSC	STR	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Post Laminectomy Syndrome with Back Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI underwent L4-5 and L5-S1 lumbar fusions on 16 October 2003 for disc herniation and spondylolisthesis, but bilateral foot drop was noted post-operatively, and she was returned to surgery a day later due to nerve impingement by the fixation screws, which were too long.  She was treated with pain medications, physical therapy and an electrical stimulation unit, and the foot drop and ankle strength eventually improved and paresthesias began to resolve.  However, in February 2004, she reported an increased in left lower back pain, and an electrodiagnostic study showed an L5 radiculopathy, left greater than right.  She was diagnosed with post laminectomy pain syndrome and treated with methadone (narcotic analgesic) and other medications.  An MRI in July 2004 showed a wide laminectomy at L4-L5 and L5-S1, with a small central disc protrusion at L5-S1; and a CT myelogram showed broken screws and hardware loosening with non-fusion in the L4-5 region.  On 16 October 2004, the CI had surgery to remove and replace the hardware.  

At the 15 February 2005 MEB NARSUM examination, 4 months prior to separation, she described significant improvement in pain as well as decreased leg numbness and weakness after the October 2004 surgery.   The examiner noted that the CI did “not have any pain at this time,” but reported some low back pain with prolonged sitting, bending, lifting, or high impact activities.   Although “limited” range of motion (ROM) was documented, “especially with flexion,” no actual measurements were in evidence.  There was no low back abnormality or muscle spasm, and neurological findings were normal.  At a family practice visit on 13 April 2005, CI denied pain or difficulties with daily activities.  There was no VA examination proximate to separation in evidence.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, coded 5243 (intervertebral disc syndrome (IVDS)).  Panel members noted that the MEB NARSUM examiner found no muscle spasms, but offered no reference to ROM, gait, or tenderness.  However, the CI reported pain with certain movements and therefore met criteria for painful motion (§4.59).  There was no evidence of IVDS which resulted in incapacitating episodes requiring physician-prescribed bed rest to warrant consideration of rating under that alternate formula.  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 back condition.  

Pain Disorder.  According to the STR and MEB NARSUM, the CI’s pain condition began in October 2001.  After the two surgeries noted above, an electrodiagnostic study showed an L5 radiculopathy, which resulted in a diagnosis of post-laminectomy pain syndrome.  Although the CI reported significant improvement in pain after the October 2004 surgery, some pain persisted and she was referred to a pain management specialist who recommended Duragesic patches and hydrocodone for breakthrough pain with good results.  She received an S2 profile and reported no pain 4 months before separation because she avoided all activities.  At a family practice follow-up on 4 February 2005, she state that her pain improved when lying down, was worse with sitting, and not worsened by walking and other associated activities.  

At the 9 February 2005 MEB NARSUM psychosocial examination, the CI reported the October 2003 surgery increased her back pain but the October 2004 surgery relieved some of the pain.  Axis I diagnoses of dysthymic disorder, alcohol dependence in early partial remission, and pain disorder associated with both psychological factors and a general medical condition, were rendered along with an Axis II diagnosis of cluster B traits (e.g. borderline) with a Global Assessment of Functioning score of 55 (moderate symptoms, impairment).  The examiner noted the CI had a significantly a debilitating dysthymic and pain disorder and personality traits that resulted in inadequate coping, alcohol abuse and recurrent occupational dysfunction.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the pain disorder 10%, coded 9422 (pain disorder, classified under somatoform disorders).  Panel members noted the NARSUM psychosocial examination reported significant disability related in part due to pain disorder, yet the February 2005 NARSUM noted no back pain at rest or with activities, and the February 2005 family practice follow-up noted pain improved with lying down and not exacerbated by walking or other activities.  The panel concluded the CI’s condition reflected mild/transient pain and most closely met criteria for 10% disability.  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 pain disorder.

Contended PEB Condition:  Dysthymia.  The panel’s main charge is to assess the fairness of the PEB determination that the contended condition was not unfitting. The commander did not cite dysthymia, and the condition did not appear to fail retention standards and was not profiled S3.  There was minimal mental health treatment demonstrated in the record.  The preponderance of evidence showed the condition did not significantly interfere with satisfactory duty performance at separation.  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 back condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the pain disorder and IAW VASRD §4.130, the panel recommends no change in the PEB adjudication.  In the matter of the contended dysthymia, the panel recommends no change from the PEB determination as not unfitting.  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.  

Dear XXXXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-05326.

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 rating modification or re-characterization 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 modification of your disability rating or characterization of your separation is not warranted.  Accordingly, I accept the recommendation that your application be denied.

						Sincerely,

		

								

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