RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXX	CASE:  PD-2013-01686
BRANCH OF SERVICE:  AIR FORCE	BOARD DATE:  20141121
SEPARATION DATE:  20041209

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty AMN/E-2 (Basic Trainee) medically separated for back pain.  The back condition did not improve adequately to meet the physical requirements for completion of training.  She was referred for a Medical Evaluation Board (MEB).  The back condition, characterized as “T12 wedge compression fracture,” was forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated the back pain condition as unfitting, rated at 10%.  The CI made no appeals and was medically separated.

CI CONTENTION:  The CI presented a lengthy contention, citing technical and diagnostic information, including range of motion evidence as well as imaging information about her back condition, which the board reviewed.

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e.(2).  It is limited to those conditions determined by the PEB to be unfitting for continued military service and those conditions identified but not determined to be unfitting by the PEB when specifically requested by the CI.  The rating for the unfitting back condition is addressed below.  No other conditions are within the defined purview of the Board.  Any conditions outside the Board’s scope of review may be eligible for consideration by the Board for Correction of Military Records.

The Board acknowledges the sentiment expressed by the CI regarding the impairment with which her back condition continues to burden her, and the significant impact it has had on her quality of life.  It is noted for the record that the Board is subject to the same laws for disability entitlements as those under which the Disability Evaluation System (DES) operates.  The DES has neither the role nor the authority to compensate members for future severity or potential complications of conditions.  That role and authority is granted to the Department of Veterans Affairs (DVA).  The Board evaluates DVA evidence in arriving at its recommendations, but its authority resides in evaluating the fairness of DES fitness and rating determinations at the time of separation.  The DVA however, is empowered to compensate for all service connected conditions and to periodically re-evaluate conditions for the purpose of adjusting the Veteran’s disability rating should the degree of impairment change over time.

RATING COMPARISON:

Service  IPEB – Dated 20040107	VA – (16 weeks Post-Separation) 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Back Pain	5237	10%	Chronic Back Pain	5235	20%	20040429	
Other x 0 (In Scope)	Other x 2	
Combined:  10%	Combined:  20%	
Derived from VA Rating Decision (VARD) dated 20040610 (most proximate to date of separation)

ANALYSIS SUMMARY:

Chronic Back Pain.  On 27 June 2003, CI fell ten feet and landed on her buttocks, subsequently was found to have a T-12 spinal compression fracture that was treated with pain medication and a back brace.  Due to the long term prognosis of her condition, MEB was initiated.  The MEB narrative summary on 3 October 2003, the examiner noted tenderness of the lower back, but commented that the CI’s condition was stable with no focal neurologic deficits. Thoracolumbar range-of-motion (ROM) was omitted during this visit.  In November 2003,
(7 weeks prior to separation), during her follow-up orthopedic appointment, the CI reported that she “was out of her brace with most activities.”  Physical examination of the back revealed no tenderness to palpation or percussion, ROM was described as full, active and without pain, with only mild lumbosacral junction discomfort.  There was no pain at the site of previous fracture.

During her VA Compensation and Pension examination in April 2004 (4 months after separation), the examiner noted mild thoracolumbar spasm from T-8 to L-2 and midline tenderness from T-11 to L-1.  Straight leg raise was negative.  Neurological exam showed no dermatomal sensory loss.  ROM testing revealed thoracolumbar flexion of 40 degrees and combined thoracolumbar ROM of 150 degrees.

The Board carefully reviewed the data from the back examinations noted above, and directed attention to its rating recommendation.  The November 2003 exam was closest to the date of surgery and therefore carries significant probative value.  At that exam, there was full, active ROM with only mild lumbosacral junction discomfort, without complaint of pain at the site of previous fracture.  The Board determined that the back pain condition was essentially non-compensable based on the Veterans Affairs Schedule for Rating Disabilities (VASRD) §4.71a General Rating Formula for Diseases and Injuries of the Spine.  However; IAW VASRD §4.40, when part of the musculoskeletal system becomes painful on use, it must be regarded as seriously disabled.  A 10% rating is warranted when there is satisfactory evidence of functional limitation due to pain.  There was no path to a higher rating since there was no evidence of a significantly disabling back condition that would justify a higher rating.

The Board also considered the matter of peripheral neuropathy.  After reviewing all the information in the record, there was insufficient evidence of a clinically significant neuropathy that interfered with performance of military duties.  Therefore, the Board concluded that there was no unfitting radiculopathy present at the time of separation.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board found insufficient cause to recommend a change in the PEB adjudication for the back pain condition.

BOARD FINDINGS:  IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB will not be considered by the Board to the extent they were inconsistent with the VASRD in effect at the time of the adjudication.  The Board did not surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD were exercised. In the matter of the chronic back pain and IAW VASRD §4.40, the Board unanimously recommends no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION:  The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20131002, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

				
XXXXXXXXXXXX
President
Physical Disability Board of Review

SAF/MRB

Dear XXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Title 10 U.S.C. § 1554a), PDBR Case Number PD-2013-01686.

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,

XXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings