RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-06001
BRANCH OF SERVICE:  Air Force	SEPARATION DATE:  20080623

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Radio Communications Systems Journeyman, medically separated for “chronic low back pain” with a disability rating of 10%.  

CI CONTENTION:  Review all conditions.  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 - 20080507	VARD - 20090617	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5243	10%	Low Back Pain	5237	20%	20090512	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI underwent L5-S1 discectomy in January 2007 for back pain and right lower extremity radiculopathy.  Postoperatively, back and radicular pain to the right foot returned.  Diagnostic imaging revealed a right L5-S1 disc bulge with mild impingement on the S1 nerve root.  The CI underwent physical therapy (PT), pain management of multiple trigger points and the sacroiliac (SI) joint, lumbar spine epidural steroid injections, lumbar medial branch blocks, lumbar radiofrequency ablation (reduce pain), and an implanted spinal cord stimulator (to mask pain signals to the brain).  

During the 25 January 2008 MEB examination, 5 months prior to separation, the CI reported constant low back pain radiating into the buttocks and down the right leg to the great toe.  There was no sensory disturbance or loss of coordination reported.  Physical examination revealed a normal gait and stance with normal movement of all extremities.  There was tenderness, muscle spasm and painful motion.  The motor examination was normal, but reflexes of the knees and ankles were absent or diminished.  On 15 February 2008, the CI had fluoroscopic placement of an implanted spinal cord stimulator.  The 11 March 2008 MEB PT range of motion (ROM) examination, 3 months prior to separation, documented flexion of 65 degrees (normal 90) and combined ROM of 160 degrees (normal 240) with painful motion.  

At the 12 May 2009 VA Compensation and Pension (C&P) examination, 11 months after separation, the CI reported constant back pain radiating to the buttocks and right leg.  Physical examination showed a slow gait, but toe and heel walk were accomplished without difficulty, and posture was slightly bent forward.  Spinal tenderness was present.  Thoracolumbar flexion was 35 degrees and combined ROM was 150 degrees with painful motion.  Pain increased with repetition but additional ROM loss was not addressed.  Lower extremity reflexes were normal.  A bilateral, lower extremity, nerve conduction study was within normal limits.  The CI declined to complete the EMG test (nerve and muscle test).  

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)).  The VA rated the back condition 20%, coded 5237 (lumbar spine strain), based on the C&P examination, citing limitation of 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), as recorded on the MEB PT ROM examination.  The panel considered the VA ROM examination an outlier, as the preponderance of STR ROM evidence supports a 10% rating.  Additionally, there was no muscle spasm 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 documentation of significant hip disability for alternative rating IAW VASRD §4.66 (sacroiliac joint), and no evidence of IVDS with incapacitating episodes which would provide for a higher rating under that formula.  

The panel next considered if an additional disability rating was justified for peripheral nerve impairment due to radiculopathy.  Radiographic studies supported radicular nerve irritation or involvement, but the MEB PT, MEB NARSUM and VA C&P examinations, and nerve conduction study, proximate to separation, revealed no objective findings of radiculopathy that would impact duty performance.  The PEB cited, and the STR confirmed, the CI had a “normal gait and balance and motor examination demonstrated no dysfunction (normal strength).”  Although the CI experienced additional pain from the nerve involvement, 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 panel’s critical decision is whether or not there was a significant motor weakness which would impact military occupation-specific activities.  There was no evidence in this case that motor weakness existed to any degree that could be described as functionally impairing.  The panel concluded the radiculopathy would not have led to an MEB and was not unfitting.  Therefore, no additional disability rating was justified on this basis.  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.  

BOARD FINDINGS:  In the matter of the back condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  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.  

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

Dear XXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-06001.

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.