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AF | PDBR | CY2013 | PD-2013-02418
Original file (PD-2013-02418.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXX    CASE: PD-2013-02418
BRANCH OF SERVICE: AIR FORCE     BOARD DATE: 20150123
SEPARATION DATE: 20050318


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Traffic Management Journeyman) medically separated for low back pain (LBP). The condition could not be adequately rehabilitated to meet the physical requirements of her Air Force Specialty but she could complete a modified physical fitness test. She was issued a temporary L4 profile and referred for a Medical Evaluation Board (MEB). The back pain condition, characterized as “chronic low back pain” 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” as unfitting, rated 10%. The CI made no appeals and was medically separated.


CI CONTENTION: “The disability rating rendered at discharge should be changed because my condition has caused a loss in my military career and my pain has become worse over the years. I was rated 10% disabled due to lower back disc and nerve injury of L4/L5 and L5/S1 along with degenerative disc disease. During the military Medical Evaluation Board (MEB) process I made the physicians aware I was experiencing, and continue to have, middle and upper back pain with tingling and throbbing neck pain and was told that pain was caused from the pain and injuries in my lower back. In addition to the back pain I also have chronic pain in the rib cage area. While I was undergoing therapeutic treatment during my enlistment, a physical therapist informed me I had a rib out of place. As it stands today, I still have chronic pain and tingling in my middle and upper back, I have lower back pain with nerve pain down my right leg, I still experience chronic rib pain and I now have tingling and numbness in my right arm and fingertips. I am 30 years of age and my condition has deteriorated. I cannot stand, sit, or walk for extended periods of time without being in pain. A simple change of weather can aggravate my symptoms and cause flare up's. I work in an office environment and primarily sit in front of a computer. The repetitive motions of using a computer cause me pain in my back and neck. l have not sought out surgery or other invasive treatments due to my age and the low success rates of such treatments. I have not been to doctor's on a regular basis because the suggested methods of treatments are all the same: pain pills, injections, and surgery. I have seen how addictive narcotics can be which is why I make the choice daily to not take such medications. The disabling conditions I have cause me physical and mental anguish. Much to my dismay, my condition has not improved and has become more problematic over time which is why I feel my condition should be rated higher than 10%.”


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 :

Service IPEB – Dated 20050202
 VA - (4 days Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Chronic Low Back Pain 5243 10% Traumatic Thoracic Spine Strain And Degenerative Disc Disease Of The Lumbar Spine With L4-5 Disc Bulge, And L5-S1 Disc Protrusion 5243 10% 20050322
Other x 0 (Not in Scope)
 Other x 2
Combined: 10%
 Combined: 10%
Derived from VA Rating Decision (VA RD ) dated 20090303 ( most proximate to date of separation [ DOS ] ).


ANALYSIS SUMMARY:

Chronic Low Back Pain: The narrative summary (NARSUM) noted the CI sustained a back injury in a motor vehicle accident on 19 February 2002. The LBP was treated conservatively but eventually began radiating down the right lower extremity (RLE). Magnetic resonance imaging (MRI) on 9 September 2002 showed degenerative disc disease and a herniated disc at L5-SI impinging on the right L5 nerve root. Neurosurgical consultation offered surgery as an option but the CI declined. According to the NARSUM the CI was returned to full duty in November 2002 and later notes indicated that this was at the CI’s request despite continued back pain. A physical medicine consultation on 21 February 2003 recommended physical therapy (PT) and epidural steroid injections. Physical medicine visits indicated the CI improved with medication and PT but there was no indication in the record that the CI had an epidural steroid injection. A visit on 25 July 2003 noted that electrodiagnostic studies (EMG) were negative without evidence of a lumbar radiculopathy. The CI experienced an increase in the back pain following a change in her duties. Repeat lumbar MRI on 14 January 2004 noted the L5-S1 disc protrusion with bilateral L5 nerve impingement, worse on the right. At a neurosurgical evaluation on 28 January 2004 the CI reported thoracic and LBP with right leg pain and occasional tingling to the right foot and thoracic spine. The examination noted tenderness but no muscle spasm. Lower extremity strength, sensation, and reflexes were normal with a positive right straight leg raise (SLR). Surgical options were discussed but the CI continued to defer surgery. Thoracic spine MRI on 26 April 2004 was normal. A note in the record on 3 June 2004 noted improvement with mild to moderate LBP, aggravated by activity, with occasional RLE symptoms, with a normal examination except “some discomfort in the lumbar region.” The CI sought a second opinion from physical medicine regarding a MEB and at the evaluation on 14 July 2004 the CI reported no relief of symptoms despite PT. The examination noted tenderness to palpation (TTP) of the lumbar area and the right sacroiliac joint, “good ROM” with pain, negative SLR, normal strength and sensation, and symmetrical reflexes. The physical medical specialist recommended proceeding with the MEB. At the MEB examination on 7 December 2004, 3 months prior to separation, the CI reported LBP. Family Practice measured the range-of-motion (ROM) for the MEB on 12 January 2005 was 80 degrees flexion (normal 90 degrees), 90 degrees bilateral rotation and 45 degrees bilateral lateral flexion, and “very limited extension.”

At the VA Compensation and Pension (C&P) examination performed 4 days after separation, the CI reported chronic low back discomfort with moderate flare-ups twice per month. The examiner noted the RLE radicular symptoms were “stated to be very rare at this time” and the CI had not had any incapacitating episodes. The examination noted a normal gait and there was TTP without muscle spasm or abnormal spinal curvature. Thoracolumbar ROM was flexion of 70 degrees with combined ROM of 160 degrees (normal 240 degrees). Strength, sensation, and reflexes were normal.

The Board directed attention to its rating recommendation based on the above evidence. The PEB rated the low back condition 10%, coded 5243 (intervertebral disc syndrome). The original VARD in not in record, but the VARD on 3 March 2009 indicated that the “current 10% rating,” coded 5243, effective the day after military separation, was continued. The Board agreed that according to current VASRD spine rules for rating the spine in effect at the time of separation the ROM evidence in record supports the 10% rating and there was no documentation of muscle spasm or guarding severe enough to cause an abnormal gait or spinal contour at the C&P exam or noted in the service treatment record proximate to separation to support a 20% rating. The Board reviewed to see if higher evaluation was achieved rating 5243 based upon incapacitating episodes but there were no incapacitating episodes documented in the record. 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 low back condition.

The Board also considered if there was evidence in the record to support recommending the RLE radiculopathy as separately unfitting and eligible for additional disability rating. Board precedent is that a functional impairment tied to fitness is required to support a recommendation for addition of a peripheral nerve rating at separation. The CI had RLE radicular pain with occasional tingling, but strength, sensation, and reflexes were normal and there was no EMG evidence of radiculopathy. The pain component of a radiculopathy is subsumed under the general spine rating as specified in §4.71a and since no evidence of functional impairment exists in this case, the Board cannot support a recommendation for additional rating based on peripheral nerve impairment.


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 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.
The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20131119, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans Affairs Treatment Record








XXXXXXXXXXXXXXX
President
DoD Physical Disability Board of Review
SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD 20762


Dear XXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Title 10 U.S.C. § 1554a), PDBR Case Number PD-2013-02418.

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,






XXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings

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