RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXX	CASE:  PD-2013-02160
BRANCH OF SERVICE:  AIR FORCE	BOARD DATE:  20141107
SEPARATION DATE:  20050214

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SrA/E-4 (3E151/HVAC Apprentice) medically separated for a back condition.  The back condition could not be adequately rehabilitated to meet the physical requirements of his Air Force Specialty or satisfy physical fitness standards.  He was issued a temporary L4 profile placed on light duty and referred for a Medical Evaluation Board (MEB).  The back condition, characterized as “chronic LBP” was forwarded to the Physical Evaluation Board (PEB) AFI 48-123.  No other conditions were submitted by the MEB.  The Informal PEB (IPEB) adjudicated “lower back pain” as unfitting, rated 10%, referencing application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) and DOD guidelines.  The CI made no appeals and was medically separated.

CI CONTENTION:  “Service connection lumbar strain has been so severe that has caused 2 spinal fusions and limited mobility with use of walking device.” [sic] 

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 and no additional conditions are within the DoDI 6040.44 defined purview of the Board.  Any conditions or contention not requested in this application, or otherwise outside the Board’s defined scope of review, remain eligible for future consideration by the Board for Correction of Military Records. 

The Board acknowledges the CI’s information regarding the significant impairment with which his service-connected condition continues to burden him; but, must emphasize that the Disability Evaluation System has neither the role nor the authority to compensate members for anticipated future severity or potential complications of conditions resulting in medical separation.  That role and authority is granted by Congress to the Department of Veteran Affairs, operating under a different set of laws.   The Board considers VA evidence proximate to separation in arriving at its recommendations and DoDI 6040.44 defines a 12 months interval for special consideration to post-separation evidence.  Post-separation evidence is probative to the Board’s recommendations only to the extent that it reasonably reflects the disability at the time of separation.

RATING COMPARISON:  
   
Service IPEB – Dated 20041018	VA - (2 Mos. Post-Separation) 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Lower Back Pain	5237	10%	Lumbar Strain	5237	10%	20050413	
Other x 0  (Not in Scope)	Other x 5	20050413	
Rating:  10%	Combined:  30%	
*Derived from VA Rating Decision (VARD) dated 20050915 (most proximate to date of separation)  

ANALYSIS SUMMARY: 

Lower Back Pain. The first record in evidence for the low back pain (LBP) was dated 2 July 2002, when the CI presented to the emergency room with an acute onset of LBP after playing basketball.  A magnetic resonance image obtained on 4 September 2003 revealed that he had a bulging disc at L5-S1 which did not impinge upon the spinal cord or nerve roots.    The CI’s back condition was managed conservatively with both duty limitation and physical therapy sessions; he did return to duty albeit he had recurrent episodes of back pain.  The CI’s neurology evaluation obtained on 17 February 2004 was normal and without radiculopathy.  X-rays images taken of the lumbar spine on 26 May 2004 were normal.  During an orthopedist appointment dated 18 June 2004, the examiner indicated that the CI was not a surgical candidate for his back condition.  The examination was unremarkable other than tenderness [to palpation] and his range-of-motion (ROM) was normal.  At a follow up physical medicine appointment dated 24 September 2004, it was noted that a trial of [steroids] injections was not beneficial, CI’s ambulated (walked) with a normal gait and neurological examination as well as ROM was within normal limits.  The CI was referred for MEB for persistent LBP.

The narrative summary (NARSUM) dated 30 September 2004 (approximately 5 months prior to separation); the CI reported a 2.5 years history of LBP “since moving a 300 pound smokestack”.  No physician prescribe incapacitation (bed rest) was documented in service treatment records (STRs).  On examination, the CI’s ROM was omitted from STRs, but motion was documented as not painful. The ambulation, neurological examination and provocative testing for nerve root irritation were all within normal range.  The back muscles were tender but without spasms and the examiner specifically noted that there was no radiculopathy present.

The VA Compensation and Pension (C&P) examination was performed on 13 April 2005 (2 months post separation), but was not in evidence for the Board’s review.  However, the VA rater did annotate their findings in the VARD dated 15 September 2005, in sufficient details which allowed usage by the Board for adjudication.  The CI reported continuous pain despite treatment.  There was mild accentuation of the normal lumbar lordosis and mild spasm from L4-S1.  Flexion was limited to 75 degrees with pain, but the ROM was otherwise normal.  No comments were made referencing the CI’s gait, but it had consistently been recorded as normal in STRs.

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB and VA both rated the back condition at 10% under coded 5237 (lumbosacral strain).  The 10% rating is supported both by the loss of flexion and painful motion as recorded in the VA C&P examination.  While spasm was present, it did not result in an abnormal gait or reversed lordosis.  Physician prescribed incapacitation was not recorded.  The Board found no route to a rating higher than that adjudicated by both the PEB and VA.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded there was insufficient cause to recommend a change in the PEB adjudication for the back 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 lower back pain condition and IAW VASRD §4.71a, 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 there be no recharacterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20131022, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

		
XXXXXXXXXXXXXX
President
Physical Disability Board of Review

SAF/MRB

Dear XXXXXXXXXXXXXX:

	Reference your application submitted under the provisions of DoDI 6040.44 (Title 10 U.S.C. § 1554a), PDBR Case Number PD-2013-02160

	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,

							
XXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings