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AF | PDBR | CY2012 | PD 2012 00284
Original file (PD 2012 00284.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:    CASE: PD1200284
BRANCH OF SERVICE: AIR FORCE     BOARD DATE: 20131213
SEPARATION DATE: 20021120


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty A1C/E-3 (3E2X1/Heavy Equipment Operator) medically separated for a back condition. He initially injured his back in a fall during basic training. The CI was diagnosed with back and left leg pain that could not be adequately rehabilitated to meet the requirements of his Air Force Specialty (AFS) or physical fitness standards, so he was referred for a Medical Evaluation Board (MEB). The back condition, characterized as “chronic back pain…,” was forwarded to the Informal Physical Evaluation Board (IPEB) IAW AFI 48-123. No other conditions were submitted by the MEB. The CI disagreed with the MEB and submitted a “letter of exception” to the IPEB. The IPEB adjudicated “chronic low back pain with radiculopathy” rated 10% . The CI did not concur and demanded a Formal PEB (FPEB). The FPEB adjudicated “chronic low back pain with radiculopathy…” rated 20%. The CI did not concur and submitted an appeal. The Secretary of the Air Force Personnel Counsel (SAFPC) responded by upholding the FPEB rating. The CI was then medically separated.


CI CONTENTION: The CI submitted a lengthy contention which was read by all members and considered by the board. In addition to increased severity of the back pain with radicular symptoms, the contention listed migraine headaches, sciatic nerve pain, acid reflux disease, weight gain, and shortness of breath/asthma.


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 low back pain with radiculopathy (which includes any associated sciatic nerve pain) is addressed below; no additional conditions are within the DoDI 6040.44 defined purview of the Board. Neither the MEB nor PEB included the migraine headaches, acid reflux disease, weight gain or shortness of breath/asthma; therefore, those conditions are not in the purview of this 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 20020815
 VA – based on Service Treatment Records (STRs)
Condition
 Code Rating Condition Code Rating Exam
Chronic Low Back Pain with Radiculopathy … 5293 20% Chronic Low Back Pain with Radiculopathy … 5293 20% STR
No Additional MEB/PEB Entries
 Other x 4 STR
Combined: 20%
 Combined: 20%
Derived from VA Rating Decision (VA RD ) dated 200 30305 .


ANALYSIS SUMMARY: 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 service 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 Veterans Affairs, operating under a different set of laws.

Chronic Low Back Pain with Radiculopathy. After his slip and fall during basic training, the CI underwent evaluation by neurosurgery and was determined to have a left lumbosacral radiculopathy in a L5 distribution that was not amenable to surgical intervention. Direct contusion of the sciatic nerve deep in the buttock was postulated. He was referred to a pain clinic on 9 January 2002, which noted lumbar radiculitis and degenerative disc disease. He was given two courses of epidural steroid injections at L4-5 without relief of his pain. The pain clinic then advanced his interventional care on 9 April 2002, with a percutaneous discectomy/nucleoplasty at L5-S1. The CI failed to progress in the resolution of his condition and was referred to a MEB. The MEB narrative summary examination completed on 17 June 2002, noted a positive straight leg raise of 50 degrees on the left without detail regarding the symptoms that were provoked by the maneuver. The maneuver on the right side was negative. Motor (strength) and reflexes were described as normal. The sensory exam showed increased sensitivity to touch over the top (dorsum) of the left foot. Due to persisting pain symptoms the CI underwent radiofrequency nerve ablation on 11 July 2002. The CI did not keep his January 2003 VA Compensation and Pension (C&P) examination. The next VA C&P examination in evidence (normal thoracolumbar range-of-motion with negative provocative maneuvers for radiculopathy noted) was from 16 October 2007, 5 years after separation.

The Board directs attention to its rating recommendation based on the above evidence. The FPEB rated the back condition 20% and coded 5293 (intervertebral disc syndrome). The VA rated the condition 20% (also under diagnostic code 5293) based on the service treatment records. The VA continued the 20% rating based on the October 2007 examination. In accordance with DoDI 6040.44, the Board is required to recommend a rating IAW the Veterans Affairs Schedule for Rating Disabilities (VASRD) in effect at the time of separation. The Board notes that the 2002 VASRD standards for the spine, which were in effect at the time of separation, were changed to the current §4.71a rating standards in 2004. The Board must correlate the above clinical data with the 2002 rating schedule (applicable diagnostic codes include: 5292 [limitation of lumbar spine motion]; 5293 [intervertebral disc syndrome (based on incapacitating episodes)]; and 5295 [lumbosacral strain]). There was no range-of-motion evidence for the Board to consider the rating under diagnostic code 5292 (limitation of lumbar spine motion). Both the PEB and VA rated 20% using code 5293 (intervertebral syndrome). Review of the service treatment records does not show incapacitating episodes requiring bed rest prescribed by a physician for a duration of at least 6 weeks to support a rating higher than the 20% adjudicated by the PEB or the VA. The Board also concluded the evidence of the record did not support a rating higher than 20% when considered under 5295(lumbar strain). The Board also considered if additional disability rating was justified for peripheral nerve impairment due to radiculopathy. The CI had left leg pain concluded to be due to radiculopathy however strength and reflexes were normal on examinations. The presence of functional impairment with a direct impact on fitness is the key determinant in the Board’s decision to recommend any condition for rating as additionally unfitting. Therefore the critical decision is whether or not there was a significant motor weakness which would impact military occupation specific activities. There is no evidence in this case that motor weakness existed to any degree that could be described as functionally impairing. The Board therefore concludes that additional disability rating was not justified on this basis. 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 chronic low back pain with radiculopathy 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 low back pain with radiculopathy 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 recharacterization of the CI’s disability and separation determination, as follows:

UNFITTING CONDITION
 VASRD CODE RATING
Chronic Low Back Pain with Radiculopathy 5293 20%
COMBINED
 20%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20130729, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record





         Physical Disability Board of Review
SAF/MRB

         Reference your application submitted under the provisions of DoDI 6040.44 (Title 10 U.S.C. § 1554a), PDBR Case Number PD-2012-00284.

         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,





 Air Force Review Boards Agency
Attachment:
Record of Proceedings

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