Search Decisions

Decision Text

AF | PDBR | CY2013 | PD-2013-01421
Original file (PD-2013-01421.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXX     CASE: PD-2013-01421
BRANCH OF SERVICE: AIR FORCE     BOARD DATE: 20141231
SEPARATION DATE: 20041115


SUMMARY OF CASE: The available evidence of record reflects that this covered individual (CI) was an active duty E-5 (Aircraft Hydraulic Systems) medically separated for low back pain (LBP). The condition did not improve adequately to meet the requirements of his Air Force Specialty or satisfy physical fitness standards. He was issued a P4/L3 profile and underwent a Medical Evaluation Board (MEB). The LBP condition was forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123. No other conditions were submitted by the MEB. The Informal PEB found the back condition unfitting and rated it 20%, with likely application of the VA Schedule for Rating Disabilities (VASRD). The CI made no appeals and was separated.


CI CONTENTION: The CI elaborated no specific contention in his 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 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 :

Air Force IPEB – Dated 20040827
 VA – (7 mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Chronic Low Back Pain 5243 20% Intervertebral Disc Syndrome 5243 20% 200 50622
Radiculopathy , of Right L eg 8520 20% 20050622
Other x 0 (Not in Scope)
 Other x 6
Rating: 20%
 Combined: 60%
Derived from VA Rating Decision (VA RD ) dated 200 50624


ANALYSIS SUMMARY:

Low back pain (LBP). In October 2003, this CI began having LBP. He also reported radicular symptoms in his right lower extremity (RLE). Magnetic resonance imaging showed L4-L5 right disc herniation, with impingement on the right L5 nerve root. He was seen by a neurosurgeon, who opined that surgery might help the leg symptoms, but would not help the back pain. The CI was treated with pain medication, physical therapy, and steroid injections. However, the LBP persisted and MEB was initiated. The MEB narrative summary was dated on 28 June 2004. The CI reported pain with prolonged sitting or prolonged standing. He also complained of numbness & tingling of the right great toe. Physical examination (PE) of the back revealed tenderness to palpation over L5-S1. Range-of-motion (ROM) was limited by pain. Straight leg raise (SLR) was positive, and there was decreased sensation to light touch of the right lateral foot.

The CI separated on 15 November 2004. A month later, on 20 December 2004, he was seen by a second neurosurgeon. PE revealed positive SLR on the right, and right L5 radiculopathy. The examiner wrote, “Symptoms are compatible with a herniated lumbar disc at L4-L5 on the right side.” On 22 June 2005, 7 months after separation, the CI had a VA Compensation and Pension (C&P) exam. He reported LBP, radiating to the RLE. He said that he had back surgery in January 2005, but the pain did not improve. His gait was antalgic. PE of the lower back revealed spasm of paraspinal muscles, and loss of lumbar lordosis. Neurological exam showed a sensory deficit on the right, and loss of the right Achilles reflex (ankle jerk). Thoracolumbar ROM was measured, and is summarized in the chart below.

Thoracolumbar ROM
(Degrees)		 VA C&P ~7 mos . Post-Sep
(20050622) p.933
Flexion (90 Normal) 45
Combined (240) 150
Comment Painful motion
§4.71a Rating 20 %
invalid font number 31502
The Board directed attention to its rating recommendation based on the above evidence. At the June 2005 C&P exam, there was 45 degrees of forward flexion. This examination was 7 months after the date of separation (DOS). The Board could not find evidence of ROM measurements closer to the DOS. Therefore, in formulating its rating recommendation, the Board leaned heavily on the June 2005 ROM exam. IAW VASRD §4.71a, a 20% disability rating is warranted when thoracolumbar forward flexion is greater than 30 degrees, but not greater than 60 degrees. The Board determined that a rating of 20% was appropriate. The Board tried to find a path to a higher rating for the back condition. However, there was insufficient evidence of a significantly disabling back condition that would justify a higher rating.

The Board also considered the matter of peripheral neuropathy. The CI clearly had radicular symptoms. However, after reviewing all the information in the record, there was not a preponderance of evidence to demonstrate a clinically significant neuropathy manifested by functional loss that interfered with performance of military duties. Therefore, the Board concluded that there was no separately unfitting radiculopathy present at the time of separation. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board found insufficient cause to recommend a change in the PEB adjudication for the back pain condition. It is appropriately coded 5243, and meets the VASRD §4.71a criteria for a 20% rating due to thoracolumbar forward flexion greater than 30 degrees, but not greater than 60 degrees.


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 LBP 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 20130810, 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-2013-01421.
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

Similar Decisions

  • AF | PDBR | CY2013 | PD-2013-01580

    Original file (PD-2013-01580.rtf) Auto-classification: Denied

    Low Back Pain (LBP) . 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...

  • AF | PDBR | CY2013 | PD-2013-02555

    Original file (PD-2013-02555.rtf) Auto-classification: Denied

    The chronic low back pain (LBP) condition characterized as “does not meet the retention standards” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. “Trunk” ROM was referred to the physical therapy note noted above. SUBJECT: Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXX, AR20150006483 (PD201302555)I have reviewed the enclosed Department of Defense Physical Disability Board of Review (DoD PDBR) recommendation and record of...

  • AF | PDBR | CY2014 | PD 2014 02448

    Original file (PD 2014 02448.rtf) Auto-classification: Denied

    No other conditions were submitted by the MEB.The Informal PEB adjudicated “chronic low back pain with degenerative disc disease”as unfitting, rated 10%, referencing application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).The CI made no appeals and was medically separated. RECOMMENDATION : The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination. I have carefully reviewed the evidence of record and the...

  • AF | PDBR | CY2014 | PD-2014-01159

    Original file (PD-2014-01159.rtf) Auto-classification: Approved

    RATING COMPARISON : Service IPEB – Dated 20060206VA – (1 week Pre-Separation)ConditionCodeRatingConditionCodeRatingExam Chronic Low Back Pain…523710%Discogenic Disease and Spinal Stenosis…524320%20060228Other x 0 (Not in Scope)Other x 3 Combined: 10%Combined: 40% *Derived from VA Rating Decision (VARD) dated 20060321 (most proximate to date of separation (DOS)) ANALYSIS SUMMARY :The Board acknowledges the CI’s contention that a higher rating should have been granted for the unfitting medical...

  • AF | PDBR | CY2012 | PD 2012 01082

    Original file (PD 2012 01082.rtf) Auto-classification: Denied

    The Board’s role is confined to the review of medical records and all evidence at hand to assess the fairness of PEB rating determinations, based on severity at the time of separation. In the matter of the chronic LBP condition, the Board unanimously recommends a disability rating of 20%, coded 5243, IAW VASRD §4.71a that was in effect at the time of separation. Physical Disability Board of Review

  • AF | PDBR | CY2013 | PD-2013-01911

    Original file (PD-2013-01911.rtf) Auto-classification: Denied

    The VA rated under a peripheral nerve code 8520 (sciatic nerve) at 40% (moderately severe) citing pain and numbness to both extremities; in addition to lumbar disc protrusion for 10% under code 5242 (degenerative arthritis).Board members first agreed that sufficient evidence of painful motion was present to justify the rating of 10%, as well as the presence of localized tenderness not resulting in abnormal gait or spinal contour IAW §4.59 and §4.71a.Next, members acknowledged the ROM values...

  • AF | PDBR | CY2013 | PD-2013-02450

    Original file (PD-2013-02450.rtf) Auto-classification: Approved

    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 MEB physical exam noted decreased sensation in the right lower leg and foot but no motor weakness.The NARSUM examiner reported that the CI “could not flex his trunk greater than 30 degrees without pain,”but did not...

  • AF | PDBR | CY2013 | PD-2013-01378

    Original file (PD-2013-01378.rtf) Auto-classification: Denied

    The MEB also forwarded fibromyalgia (FM) and seasonal allergic rhinoconjunctivitis conditions as medically acceptable.The Informal PEBadjudicated “degenerative disk disease associated with herniated nucleus pulposus L5-S1 with left radicular pain” as unfitting, rated 20%, citing the VA Schedule for Rating Disabilities (VASRD). 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...

  • AF | PDBR | CY2013 | PD-2013-01347

    Original file (PD-2013-01347.rtf) Auto-classification: Approved

    The Informal PEB found the“chronic back pain, status post lumbar fusion” unfitting, rated 10%, with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD). Post-Separation)ConditionCodeRatingConditionCodeRatingExam Chronic Back Pain, Status Post Lumbar Fusion524110%Herniated Nucleus Pulposus (HNP)524310%20040709Bladder Dysfunction, related to HNP5243-754210%20040709Other MEB/PEB Conditions x 0 (Not in Scope)Other x 3 RATING: 10%RATING: 20% *Derived from VA...

  • AF | PDBR | CY2014 | PD 2014 03102

    Original file (PD 2014 03102.rtf) Auto-classification: Denied

    The PEB and VA both rated the back condition at 20% for decreased spinal ROM using different codes;the PEB used code 5241 (spinal fusion) and the VA, code 5237,(lumbosacral strain), IAW VASRD §4.71a.A rating of 20%, under both codes, requires forward flexion of the thoracolumbar spine of greater than 30 degrees but not greater than 60 degrees.The next higher rating, 40%, under both codes requires forward flexion of 30 degrees or less or ankylosis of the entire thoraco- lumbar spine. ...