RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXX	CASE:  PD-2014-00624
BRANCH OF SERVICE:  AIR FORCE	BOARD DATE:  20140829
SEPARATION DATE:  20070511

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SSGT/E-5 (2A373/Tactical Aircraft Maintenance) 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 permanent L4 profile and referred for a Medical Evaluation Board (MEB).  The back condition, characterized as “chronic low back pain (LBP) post laminotomy-microdiskectomy, L4-5,” was forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated “low back pain due to degenerative disc disease (DDD) status post fusion at L4-S1” as unfitting, rated 10%, referencing application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The PEB adjudicated bilateral polycystic kidney disease as a Category II condition.  The CI appealed to the Formal PEB (FPEB) which increased the rating to 20%.  The CI made no further appeals and was medically separated.

CI CONTENTION:  The CI wrote “Degenerative disk disease, tinnitus, psoriasis, scar, residual.”

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 additional conditions are within the DoDI 6040.44 defined purview of the Board.  The tinnitus, psoriasis and scar conditions were not identified by the PEB and thus are not 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.

RATING COMPARISON:

Service FPEB – Dated 20070323	VA - (10 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
LBP due to DDD s/p Fusion…	5241	20%	DDD L4-5 and L5-S1…	5242	10%	20080324	
Other x 1 (Not is Scope)	Other x 14 (Not in Scope)	20080324	
Rating:  20%	Combined:  30%	
Derived from VA Rating Decision (VARD) dated 20080514 (most proximate to date of separation)

ANALYSIS SUMMARY:  IAW DoDI 6040.44, the Board’s authority is limited to making recommendations on correcting disability determinations.  The Board’s role is thus confined to the review of medical records and all evidence at hand to assess the fairness of PEB rating determinations, compared to VASRD standards, based on ratable severity at the time of separation.

LBP due to DDD s/p Fusion L4-S1.  The CI was first evaluated for LBP in early 2005.  He was initially managed conservatively with duty restriction and medications, but his pain persisted.  He then had a magnetic resonance imaging (MRI) on 26 March 2005 which showed multi-level DDD and a herniated disc (HNP) at L4-5.  He was referred to a spine surgeon who obtained a second MRI which on 17 August 2005, showed some progression of the DDD and an incidental finding of probable polycystic kidney disease.  Renal dysfunction was not present and he underwent back surgery on 16 November 2005 with fusion of L4-S1, debridement of the discs and placement of hardware.  Post-operatively, he did well and reported no LBP at a 1 December 2006 primary care appointment.  However, his duty restrictions precluded both deployment and full duty as an aircraft mechanic; accordingly, he was entered into the MEB process.  

The narrative summary (NARSUM) was 5 months prior to separation.  The examiner noted that there was a solid fusion on x-ray, but did not include a physical examination.  The range-of-motion (ROM) was noted as “fine.”  At the VA Compensation and Pension (C&P) examination (performed 10 months after separation), the CI reported morning stiffness, but denied incapacitation and was able to garden and mow the lawn.  He was working as a “Ditch Witch” operator, which he had done for the past 9 months.  His posture and gait were normal.  Neither spasm nor tenderness was present; provocative maneuvers for radicular pain were negative.  The ROM was reduced to 70 degrees in flexion (normal 90 degrees) and the combined ROM was 200 degrees (normal 240 degrees).

The Board directed attention to its rating recommendation based on the above evidence.  The FPEB rated the back at 20% using the code 5241 for spinal fusion.  The VA rated the back at 10% using the code 5242, degenerative arthritis.  The VA C&P examination and the information in the NARSUM and last clinical note do not support a rating higher than 10%.  However, the Board does not recommend a rating lower than that assigned by the PEB.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the LBP 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 LBP 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 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 20140127, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

		
XXXXXXXXXXXXXX
President
DoD 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-2014-00624.

	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