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AF | PDBR | CY2013 | PD-2013-01255
Original file (PD-2013-01255.rtf) Auto-classification: Approved
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXXXX       CASE: PD-2013-01255
BRANCH OF SERVICE: AIR FORCE     BOARD DATE: 20141126
SEPARATION DATE: 20091104


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-6 (Geospatial Intelligence Analyst Craftsman) medically separated for a back condition. The condition could not be adequately rehabilitated to meet the physical requirements of his Air Force Specialty. He was placed on limited duty and referred for a Medical Evaluation Board (MEB). The back condition, characterized as “degenerative disc disease” was forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123. No other conditions were submitted by the MEB. The Informal PEB adjudicated “chronic low back pain, status-post charite disc replacement” as a Category I, rated at 0% citing criteria of the Veterans Affairs Schedule for Rating Disabilities (VASRD). The PEB also adjudicated an obesity condition as a Category III. The CI made no appeals and was medically separated.


CI CONTENTION: “Original determination of my medical evaluation board did not take into consideration the lingering effects from my surgery. I was able to retain full range of motion of my lower back post-surgery, but any and all continued work requiring bending over, excessive use of stairs, lifting of objects (to include children), or long periods of walking cause moderate to severe discomfort/pain of the lower back. Long periods of sitting/standing to include sitting at restaurants, long car drive, plane rides, standing required for work, all cause moderated to severe lower back pain. The back pain resonates across my lower back to include discomfort in the right hip. I have also experienced numbness in my right leg following extended periods of standing/sitting. The lower back discomfort/pain is also agitated by sexual intercourse. It can cause pain and discomfort that may last up to two days.”


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. In addition, the Board will review any potential unfitting radiculopathy with respect to the unfit back condition in accordance with application of the general rating formula for the spine; and therefore the contented right leg condition will be reviewed as part of this process. 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.







RATING COMPARISON :

Service IPEB – Dated 20090930
 VA - (4 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Chronic Low Back Pain, Status-post Charite’ Disc Replacement 5243 0 Disc Replacement L4-L5 (Also Claimed as Lumbar Radiculopathy T9-10 Disc Protrusion with Back Pain and Sacral Ankylosis) 5239 10% 20100308
Obesity Category III No VA Entry
Other x 0 (Not In Scope)
 Combined: 40%
Combined: 0%


ANALYSIS SUMMARY:

Chronic Low Back Pain Condition. The narrative summary (NARSUM) noted the CI sustained an injury to his back in December 2003 that resolved with treatment, but reappeared in mid-2004. Magnetic resonance imaging (MRI) of the back in July 2004 was reported as normal. A second MRI in January 2005, obtained for continued back pain, revealed disc disease in the lower back and a tear of the cartilage of the disc (annular tear). The CI underwent neurosurgical removal and replacement of the disc with an “artificial” disc (Charite Disc) in March 2009. The CI had continued post-operative back pain and underwent the MEB process in November 2006, but was found fit for duty. CT Myelogram, performed on 8 March 2008, revealed some dysfunction of the replaced disc. No surgery was recommended. At the second MEB exam on 4 May 2009 (6 months prior to separation), the CI was reported to be in no distress. Range-of-motion (ROM) of the back was reported to be “full.” Additional findings are summarized in the chart below. On a clinic evaluation dated 26 May 2009, the CI reported increasing back pain after injuring his back while jumping a week prior. Exam at this time revealed a “full” ROM with painful motion. On 9 June 2009, the CI was reported “not to have a full ROM of the back” and standing posture was not “erect.” During physical therapy (PT) evaluation on 17 August 2009 (approximately 3 months prior to separation), the CI had normal gait and posture. Motor and sensory exams were normal. Findings on examination of the spine are summarized in the chart below. All surgical scars were described as well healed.

At the VA Compensation and Pension (C&P) exam (performed 4 months after separation), the CI reported no “flare-ups” of back pain, no incapacitation, no bowel or bladder problems and no weakness, numbness or tingling in his lower legs. Motor and sensory exams were normal. Findings on examination are in the chart below. The goniometric active ROM evaluations in evidence, which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized below.

Thoracolumbar A ROM
(Degrees)		 PT ~8Mo. Pre-Sep
(20090310) p.147
NARSUM~6 Mo Pre-Sep(20090504) p 135		 PT ~2.5 Mo. Pre-Sep
(20090817) p.1006
 VA C&P ~4 Mo. Post-Sep
(20100308) p.230
Flexion (90 Normal ... wnl ) 90, 90, 90 Full 80 with pain 80 no pain
Extension (30) 10, 10, 10 Full 20 20
Comment No pain; no tenderness; No DeLuca No pain; Motor, sensory, reflexes wnl Gait wnl; motor, sensory wnl No spasm; motor, sensory, reflexes wnl . No DeLuca
invalid font number 31502                                       invalid font number 31502
The Board directed attention to its rating recommendation based on the above evidence. The PEB rated the back pain condition 0%, coded 5243 (spinal fusion) citing painless, normal ROM of the spine. The VA rated the back pain condition 10%, coded 5239 (spinal instability), citing a reduced spinal ROM of 80 degrees. Under both codes, IAW §4.71a, a rating of 10% requires forward flexion of the thoracolumbar spine greater than 60 degrees, but not greater than 85 degrees. The next higher rating, 20%, requires forward flexion of the thoracolumbar spine of greater than 30 degrees, but not greater than 60 degrees. The Board noted the CI had a “normal ROM of the spine” on the NARSUM evaluation. The record in evidence documented the CI sustained an additional injury having impact on the back after this exam. The Board unanimously agreed the evidence in closest proximity to the date of separation, the PT evaluation of August 2009 (3 months prior to separation) and the C&P evaluation (4 months after separation), were probative and both supported a rating of 10% using ROM criteria for a reduced spinal flexion of 80 degrees. The Board considered a rating IAW §4.123 (neuritis, peripheral nerve). The Board agreed there was no ratable peripheral neuropathy in this case since no motor weakness was present, sensory symptoms had no functional implication and radiation of pain was subsumed under the back rating IAW §4.71a. The Board considered a rating under code 5243, (incapacitating episodes/intervertebral disc syndrome). An incapacitating episode is defined as a period of acute signs and symptoms due to intervertebral disc syndrome that requires bed rest prescribed and treated by a physician. The record documents no incapacitation under this definition in the 12-month period prior to the MEB examination. The Board agreed that no rating could be recommended under this code. The Board unanimously agreed that the record in evidence did not support a compensable rating for code 7804 (scars), as surgical scars were well-healed, non-tender or irritated; and there was no evidence that they were duty limiting. The Board found no other appropriate codes for consideration and no pathway to a rating higher than 10% for the back condition. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% 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 back pain condition, the Board unanimously recommends a disability rating of 10%, coded 5241 IAW VASRD §4.71a. There were no other conditions within the Board’s scope of review for consideration.


RECOMMENDATION The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation:

UNFITTING CONDITION VASRD CODE RATING
Low Back Pain 5241 10%
COMBINED 10%



The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20130612, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record








                                   
XXXXXXXXXXXXXXXXXXXX
President
DoD 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-2013-01255.

         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 not appropriate under the guidelines of the Veterans Affairs Schedule for Rating Disabilities. Accordingly, the Board recommended modification of your assigned disability rating without re-characterization of your separation with severance pay.

         I have carefully reviewed the evidence of record and the recommendation of the Board. I concur with that finding, accept their recommendation and direct that your records be corrected as set forth in the attached copy of a Memorandum for the Chief of Staff, United States Air Force. The office responsible for making the correction will inform you when your records have been changed.

                                                               Sincerely,
XXXXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency
Attachments:
1. Directive
2. Record of Proceedings

cc:
SAF/MRBR

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