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AF | PDBR | CY2012 | PD2012 00745
Original file (PD2012 00745.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXXXX                CASE: PD1200745
BRANCH OF SERVICE: AIR FORCE              BOARD DATE: 20130905
SEPARATION DATE: 20021206


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty Senior Airman/E-4 (3N052/Radio and TV Broadcast Journeyman) medically separated for chronic low back pain (LBP) with sacral sacroiliac dysfunction syndrome and muscle inflexibilities and iliac rotation. The condition could not be adequately rehabilitated to meet the physical requirements of her Air Force Specialty or satisfy physical fitness standards. She was issued an L4 profile and referred for a Medical Evaluation Board (MEB). The chronic low back and sacral pain consistent with sacroiliac dysfunction syndrome with evidence of muscle inflexibilities and ilial rotation condition was forwarded to the Informal Physical Evaluation Board (IPEB) IAW AFI 48-123. No other conditions were submitted by the MEB. The IPEB adjudicated the low back condition as unfitting rated 10% citing criteria of Department of Defense guidelines and the Veterans Affairs Schedule for Rating Disabilities (VASRD). The CI appealed to the Formal PEB and then to the Secretary of the Air Force Personnel Council, both of which affirmed the IPEB findings and ratings. The CI was then separated.


CI CONTENTION: The CI elaborated no specific contention in her application.


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 condition is addressed below; no additional conditions are within the Board’s defined DoDI 6040.44 purview. 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:

SAFPC – Dated 20021018
 VA - (~ 4 & 6 Mos. Post-Separation*)
Condition
 Code Rating Condition Code Rating Exam
Chronic Low Back Pain w/ Sacral Sacroiliac Dysfunction Syndrome & Muscle Inflexibilities & Iliac Rotation
 5294 10% Sacroiliac Dysfunction Syndrome 5294 10% 200304/06xx*
No Additional MEB/PEB Entries
 Other x 3 200304/06xx*
Combined: 10%
 Combined: 20%
Derived from VA Rating Decision (VA RD ) dated 20030702 (most proximate to date of separation [ DOS ] ).
*200304 and 200306 C&P Exams are not available for review, but VARD 20030702 refers to them.

ANALYSIS SUMMARY: IAW DoDI 6040.44, the Board’s authority is limited to making recommendations to correct military service disability determinations. The Board’s role is confined to review of medical records and available evidence to assess the fairness of PEB ratings, using VASRD standards, to determine ratable functional severity at the time of separation.

Chronic Low Back Pain Condition. The CI developed back pain without injury in 1999. Imaging studies revealed a developmental variant of the right L5 vertebra. An orthopedist did not recommend surgery. She was treated with anti-inflammatory medications, physical therapy, narcotic pain medications, osteopathic manipulation and activity restrictions via profiles. Though these treatments gave some improvement, she was unable to meet the physical demands of her military duties and she was referred to the MEB. The narrative summary noted that the CI was not suffering from rest pain and she only had the right sacroiliac pain with heavy lifting and repetitive lifting that she incurred while on the job. The MEB physical exam (7 months prior to separation) noted a normal posture, gait, and spine contour. She had mild paraspinal tenderness and muscle spasm. Range-of-motion (ROM) measurements were not provided in any plane, but were stated to be normal for lateral flexion and rotation. “Full flexion of the trunk” was also present. Painful extension was reported; pain was also elicited during several lumbar spinal maneuvers. She had normal strength and neurological exam of the lower extremities and straight leg raise testing was negative for radiculopathy. Two VA Compensation and Pension exams performed about 4 and 6 months after separation were not in evidence, but were referenced in the VA ratings decision (dated 2 July 2003). The CI reported that her pain had greatly reduced since leaving the military, but she was unable to lift more than 60-80 pounds or stand longer than 2 hours. She denied pain radiation or muscle spasm. The examination reportedly showed normal posture and gait. Bilateral paraspinal lumbar tenderness was present. Measured ROM showed flexion of 95 degrees (normal to 90 degrees by current standards), extension of 35 degrees with pain (normal 30 degrees), right and left lateral flexion of 40 degrees each (normal 30 degrees) and right and left rotation of 35 degrees (normal 30 degrees). There was reportedly no additional limitation due to fatigue, weakness, lack of endurance or incoordination.

The Board directs attention to its rating recommendation based on the above evidence. The 2002 VASRD coding and rating standards for the spine, which must be applied to the Board’s recommendation IAW DoDI 6040.44, differ from the current §4.71a general rating formula for the spine. The applicable available coding options for this case are excerpted below.

5292 Spine, limitation of motion of, lumbar:
Severe ................................................................................40
Moderate ...........................................................................20
Slight ..................................................................................10

5293 Intervertebral disc syndrome:
With incapacitating episodes having a total duration of at least two weeks but less than four
weeks during the past 12 months ...........................................20
With incapacitating episodes having a total duration of at least one week but less than two
weeks during the past 12 months ...........................................10

5294 Sacro-iliac injury and weakness:
5295 Lumbosacral strain:
Severe; with listing of whole spine to opposite side, positive Goldthwaite’s sign, marked limitation
of forward bending in standing position, loss of lateral motion with osteo-arthritic changes, or narrowing or irregularity of joint space, or some of the above with abnormal
mobility on forced motion ....................................................... 40

With muscle spasm on extreme forward bending, loss of lateral spine motion, unilateral, in
standing position ......................................................................20
With characteristic pain on motion ............................................10
With slight subjective symptoms only ..........................................0

The PEB and VA each assigned a 10% rating under the 5294 code. “Characteristic pain on motion” is reasonably conceded given the CI’s history and physical examination findings. Evidence meeting the criteria for a higher rating under that code was not present. The Board agreed there were no limitation of motion and no evidence of incapacitating episodes to support a compensable rating under the 5292 or 5293 codes. 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 lower back pain.


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. As discussed above, PEB reliance on DoD guidelines for rating LBP was operant in this case and the condition was adjudicated independently of that instruction by the Board. In the matter of the low back 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
Low Back Pain 5294 10%
COMBINED 10%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20120608, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record





XXXXXXXXXXXXXXXXXXXX, DAF
President
Physical Disability Board of Review



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

          Reference your application submitted under the provisions of DoDI 6040.44 (Title 10 U.S.C. §  1554a), PDBR Case Number PD-2012-00745.
         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,





 XXXXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency
Attachment:
Record of Proceedings

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