RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2014-00325
BRANCH OF SERVICE:  AIR FORCE	BOARD DATE:  20141031
SEPARATION DATE:  20050926

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Security Forces Journeyman) medically separated for a low back condition.  The back condition could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty or satisfy physical fitness standards.  She was issued a temporary P3 profile and referred for a Medical Evaluation Board (MEB).  Bilateral pars defect at L5 without spondylolisthesis was forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123.  No other condition was submitted by the MEB.  The Informal PEB adjudicated bilateral pars defect at L5 without spondylolisthesis as unfitting, rated 10%, with application of the VA Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  “When discharged I was in constant pain, lost some ROM and was unable to perform my assigned duties.  Here I am 9 years later w/ increased issues (numbness) and now neck issues that may have been related to the fall.”

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 when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting.  Any conditions outside the Board’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/Naval Records.  Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation.  The Board 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, operating under a different set of laws.  The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation. 

RATING COMPARISON:

Service IPEB – Dated 20050810 | VA - (2 Mos. Post-Separation)
Condition | Code | Rating | Condition | Code | Rating | Exam
Bilateral Pars Defect at L5 without Spondylolisthesis | 5239 | 10% | Spondylolisthesis L5-S1 | 5239 | 10% | 20051121
Other x 0 (Not in Scope) | Other x 4 | 20051121
Rating:  10% | Combined:  20%*
Derived from VA Rating Decision (VARD) dated 20051209 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Bilateral Pars Defect at L5 without Spondylolisthesis.  At the MEB narrative summary examination dated approximately 3 months prior to separation, the CI reported continued lower back pain since July 2004 without relief following conservative therapy including physical therapy and a stabilization brace.  There was muscle spasm with pain at times, without bowel, bladder or lower leg symptoms.  Imaging documented bilateral pars defects at L5/S1 without evidence of significant spondylolisthesis.  Exam documented tenderness of the lower back paraspinal muscles and range-of-motion (ROM) “of lower lumbar limited to flex/extend/rotation due to pain.”  Straight leg raise testing (for radiculopathy) was negative.  A physical therapy note 11 months prior to separation had indicated full active ROM of the thoracolumbar spine.  There were no periods of physician prescribed bed rest documented.

At the VA Compensation and Pension exam dated approximately 2 months after separation, the CI reported episodes of radiating pain to her left knee and calf.  Exam documented a normal gait, with ability to walk on heels and on toes.  Straight leg raise testing was negative and ROM was flexion of 90 degrees (normal 90 degrees) with pain and combined ROM of 240 degrees (normal 240 degrees) and no decrease on repetition.  No muscle spasm, atrophy or neurovascular deficit was noted.  A VA exam performed in December 2008, (over 3 years remote from separation) documented thoracolumbar forward flexion of 30 degrees (normal 90 degrees) which the VA rated at 40%.

The Board directs attention to its rating recommendation based on the above evidence.  The PEB and VA both rated the lower back condition at 10% using code 5239 (	Spondylolisthesis or segmental instability).  All exams proximate to separation warranted a 10% rating level for painful motion.  There was no indication of muscle spasm or guarding severe enough to result in an abnormal gait, abnormal spinal contour, periods of incapacitation, or more limited ROMs (forward flexion not greater than 60 degrees or combined not greater than 120 degrees) that would allow for any rating higher than 10%.  The VA exam over 3 years post-separation was adjudged post-separation worsening and not indicative of the CI’s disability picture proximate to separation.  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 lower 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 low back (bilateral pars defect at L5 without spondylolisthesis) 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 20131230, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

XXXXXXXXXXXX
President
DoD Physical Disability Board of Review

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

XXXXXXXXXXXXXXX
XXXXXXXXXXXXXXX
XXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Title 10 U.S.C. § 1554a), PDBR Case Number PD-2014-00325.

	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,

XXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings

PD-2014-00325