Search Decisions

Decision Text

AF | PDBR | CY2013 | PD-2013-02161
Original file (PD-2013-02161.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXX     CASE: PD-2013-02161
BRANCH OF SERVICE: AIR FORCE    BOARD DATE: 20141023
SEPARATION DATE: 20050615


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SSGT/E-5 (2S071/Supply) medically separated for a chronic back pain condition. 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 a L4 profile and referred for a Medical Evaluation Board (MEB). The chronic back pain condition 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 (LBP) status post (s/p) lumbar fusion” as unfitting, rated 10%, citing criteria of the VA Schedule for Rating Disabilities (VASRD). The PEB also adjudicated hypertension, seasonal allergic rhinitis, gastroesophageal reflux disease and herpes simplex virus Type I conditions as Category II (can be unfit, but not compensable/ratable). The CI made no appeals and was medically separated.


CI CONTENTION: “The chronic nature of the neuropathy in my leg can be debilitating and disable me from doing every day activities and duties required of me at my job. The pain is always there and is hard at times to manage the pain and the disappointment of not being able to do things. I would like and need to do. It has been a life altering problem that I deal with on a daily basis.”


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; and, 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 20050426
 VA - (4 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Chronic Low Back Pain Status Post Lumbar Fusion 5241 10% Spondylolisthesis Of The Lumbar Spine, s/p Laminectomy and Fusion, with Degenerative Disk Disease 5239 20% 20051028*
Other x 0 (In Scope)
 Other x 11
Combined: 10%
 Combined: 20%
Derived from VA Rating Decision (VA RD ) dated 20060112 ( most proximate to date of separation [ DOS ] ). *Exam is Missing.



ANALYSIS SUMMARY:

Chronic Low Back Pain Condition. The CI experienced chronic low back pain that radiated into the right leg. Magnetic resonance imaging (MRI) performed on 30 May 2003 demonstrated degenerative disc and spine disease at L4-5 and L5-S1 with mild slippage of the L5 vertebra on the sacrum (L5-S1 spondylolisthesis). The MRI showed narrowing of the openings (foramen) for the spinal nerve roots to pass without compression of the spinal nerve roots. Spine surgery consultation noted right L5 radicular symptoms without leg weakness. The CI did not receive benefit from non-operative treatment including injections and underwent low back surgery on 29 October 2003. The surgery involved removal of the intervertebral disc, enlargement of the foramen (openings) for the L5 and S1 spinal nerve roots and fusion with placement of hardware and bone grafting at the L4-5 and L5-S1 levels. Spine surgery clinic records indicate satisfactory recovery following surgery. No mention of a residual radiculopathy is made by the spine surgeon.

According to the MEB narrative summary dated 14 March 2005, the CI continued to experience “mild chronic pain” with activity limitations including no heavy lifting or running. A detailed spine examination was not recorded. A clinic examination performed on 24 February 2005, recorded localized tenderness. The gait was normal and there was no focal weakness. A positive Laseague test on the right for radicular symptoms were recorded, however the examiner thought the radiating pain was due to gluteal muscle spasm rather than spinal nerve root compression at the lumbar spine.

At the VA Compensation and Pension (C&P) examination performed on 23 September 2005, 3 months after separation, the CI reported persistent chronic pain aggravated by activity. There was “some radiation” of pain into the right lower extremity. Lifting was limited to 30 pounds, she could walk up to a mile, perform house work, shop and drive. On examination the spinal curvature and the gait were normal. There was tenderness and a mild degree of muscle spasm in the para-lumbar region. Back range-of-motion was flexion 70 degrees (normal 90), extension 15 degrees (normal 30), left lateral flexion 25 degrees (normal 30), right lateral flexion 25 degrees (normal 30), left rotation 25 degrees (normal 30) and left rotation 25 degrees (normal 30). The examiner noted that after repetitive motion, the flexion was reduced by 10 degrees. Muscle strength was “somewhat weakened” in the right hamstring (back of the thigh muscle), but otherwise lower extremity strength was preserved including muscles innervated by the L5 and S1 spinal nerve roots. Muscle mass was normal without atrophy (loss of muscle mass due to injury or lack of use). There was abnormal sensation in an L5 distribution of the leg and foot and on the lateral thigh. Achilles reflexes were normal (S1 nerve root) while the knee (quadriceps) reflex was decreased (however that reflex is controlled by spinal nerve roots from spine levels (L2, L3, and L4) not affected by the CI’s spine condition).

The Board directed attention to its rating recommendation based on the above evidence. The PEB rated the chronic LBP s/p lumbar fusion 10%, coded 5241 (spinal fusion). The VA rated the back condition 20% (coded 5239, spondylolisthesis), citing the VA C&P examination showing flexion decreasing by 10 degrees after repetition from 70 degrees to 60 degrees. The VA also granted a separate 10% rating for right lower extremity L5 neuropathy (coded 8526, femoral nerve). The VA C&P examination proximate to separation described above provided a detailed examination upon which the Board was able to base a rating recommendation. The limitation of motion following repetition at the VA C&P examination more nearly approximated the 20% rating for limitation of flexion greater than 30 but not greater than 60 degrees. Although the CI had radiating pain, there was no intervertebral disc herniation causing an intervertebral disc syndrome and there were no incapacitating episodes requiring bed rest prescribed by a physician to support consideration under the alternate formula for rating intervertebral disc syndrome based on incapacitating episodes. The Board also considered if additional disability rating was justified for peripheral nerve impairment due to radiculopathy. The CI had radiating pain in a L5 pattern in the right lower extremity. The spine surgery notes did not indicate a significant residual radiculopathy with objective weakness. The VA C&P examination noted a somewhat weakened hamstring muscle but lower extremity strength was otherwise normal and gait was normal. The Board also noted that the hamstring muscle is innervated by multiple spinal nerve roots L5, S1, S2 and S3 so significant weakness from a single nerve root is not expected. There were sensory changes noted. 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. While the CI may have suffered additional pain from the nerve involvement, this is subsumed under the general spine rating criteria, which specifically states “with or without symptoms such as pain (whether or not it radiates).” 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 recommends a disability rating of 20% for the chronic LBP s/p lumbar fusion (5241).


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. In the matter of the chronic LBP s/p lumbar fusion condition, the Board unanimously recommends a disability rating of 20%, 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 the CI’s prior medical separation:

UNFITTING CONDITION VASRD CODE RATING
Chronic Low Back Pain Status Post Lumbar Fusion 5241 20%
COMBINED 20%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20131023, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record








                                   
XXXXXXXXXXXXXX
President
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-2013-02161.

         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,






 XXXXXXXXXXXXXX
Director
Air Force Review Boards Agency
Attachments:
1. Directive
2. Record of Proceedings

cc:
SAF/MRBR
DFAS-IN

Similar Decisions

  • AF | PDBR | CY2013 | PD-2013-02301

    Original file (PD-2013-02301.rtf) Auto-classification: Denied

    The VA increased their radiculopathy rating, but maintained the 40% back rating until a subsequent exam in 2012 led to a decreased spine rating of 20%. RECOMMENDATION : The Board recommends that the CI’s prior determination be modified as follows; and, that the discharge with severance pay be recharacterized to reflect permanent disability retirement, effective as of the date of his prior medical separation: XXXXXXXXXXXXXXX President Physical Disability Board of Review

  • AF | PDBR | CY2013 | PD-2013-02598

    Original file (PD-2013-02598.rtf) Auto-classification: Denied

    Also noted was “decreased sensation over T12-L1 dermatomal areas to include genitalia.” This examiner also reported the absence of any lower extremity muscle weakness. Undeniably the CI suffered additional lower extremity pain from the nerve involvement, but this is subsumed under the general spine rating criteria, which specifically states “with or without symptoms such as pain (whether or not it radiates).” The lower extremity pain components in this case have no functional implications. ...

  • AF | PDBR | CY2013 | PD-2013-01718

    Original file (PD-2013-01718.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 VASRD standards to the unfitting medical condition at the time of separation. Post-Separation) ConditionCodeRatingConditionCodeRatingExam Low Back Pain Following Lumbar Fusion524110%Status Post Lumbar Spine Fusion, with Retained Hardware at L4-5 and L5-S1, with Bone Grafting from Left iliac Crest and Left Sciatica (also Claimed as Numbness in...

  • AF | PDBR | CY2013 | PD-2013-01439

    Original file (PD-2013-01439.rtf) Auto-classification: Denied

    At the CI’s post-operative visit with his Neurosurgeon, 19 months prior to separation, the CI stated that he “ [did] get occasional lumbar discomfort if he [sat] for prolonged period of time … o/w [the CI was] doing very well.” The neurosurgeon documented that the CI “ [arose] from a chair to a standing position without difficulty.” At a PT evaluation, approximately 16 months prior to separation, the CI stated that his pain level was a “2.5/10” and his “back is doing pretty good but does...

  • AF | PDBR | CY2009 | PD2009-00264

    Original file (PD2009-00264.docx) Auto-classification: Denied

    Low Back Pain . Exam of the lower extremities showed normal strength, sensation and reflexes bilaterally. In the matter of the painful back condition, the Board unanimously recommends a rating of 20% for Chronic Low Back Pain (coded 5241) IAW VASRD §4.71a.

  • AF | PDBR | CY2013 | PD2013 00193

    Original file (PD2013 00193.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, compared to Veterans Affairs Schedule for Rating Disabilities (VASRD) standards, based on severity at the time of separation. Degeneration of the disc was noted, but no evidence of nerve root compression or radiculopathy were presented.Although surgical records were not in evidence, the available service treatment records indicated he underwent L4-S1...

  • 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. ...

  • AF | PDBR | CY2013 | PD2013 02511

    Original file (PD2013 02511.rtf) Auto-classification: Denied

    The rating for the unfitting spinal fusion condition is addressed below; and, no additional conditions are within the DoDI 6040.44 defined purview of the Board. Pre-SepVA C&P ~ At SepFlexion (90 Normal) 8 5 (84)70 Extension (30) 25 ( 23 )15 R Lat Flexion (30) 3030 L Lat Flexion (30) 3030 R Rotation (30) 3030 L Rotation (30) 3030 Combined (240) 230205 Comment +tenderness , painful motion +painful motion §4.71a Rating 10% 10%The Board directs attention to its rating recommendationbased on the...

  • AF | PDBR | CY2014 | PD-2014-01251

    Original file (PD-2014-01251.rtf) Auto-classification: Denied

    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. RECOMMENDATION : The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination. DoD Physical Disability Board of Review

  • AF | PDBR | CY2009 | PD2009-00684

    Original file (PD2009-00684.docx) Auto-classification: Denied

    After due deliberation, considering all of the evidence and mindful of VA Schedule for Rating Disabilities (VASRD) §4.3 (reasonable doubt), the Board concluded that the CI’s back condition most nearly approximated the 40% rating IAW the VASRD general rating formula for spine diseases, thoracolumbar flexion 30° or less. The Board thus has no basis for recommending any additional unfitting conditions for separation rating. Subj: PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATION