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AF | PDBR | CY2013 | PD-2013-02503
Original file (PD-2013-02503.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXX     CASE: PD-2013-02503
BRANCH OF SERVICE: AIR FORCE     BOARD DATE: 20141210
SEPARATION DATE: 20050411


SUMMARY OF CASE : Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5 ( Aviation Resource Management Craftsman) medically separated for a lumbar spine condition which could not be adequately rehabilitated to meet the requireme nts of her Air Force Specialty or physical fitness standards . S he was issued a P4 temporary profile and referred for a Medical Evaluation Board (MEB). The back condition, characterized as “ chronic low back pain” and “degenerative disk disease , ” was forwarded to the Physical Evaluation Board (PEB) IAW AFI 48- 123 with n o other conditions submitted by the MEB. The I nformal PEB (IPEB) adjudicated “chronic low back pain associated with degenerative disc disease [DDD] ” as unfitting, rated 10 % , citing criteria of the VA Schedule for Rating Disabilities (VASRD) . The CI appealed the fitness determination to the Formal PEB (FPEB) , which affirmed the I PEB finding and rating . The CI did not agree with the FPEB, but did not submit a written rebuttal. The Secretary of the Air Force Personnel Council upheld the findings of the FPEB and IPEB . T he CI submitted no further appeals and was medically separated.


CI CONTENTION: “Degenerative disc disease bulging discs worsened by USAF and deployments”


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; 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 FPEB – Dated 20050214
 VA (~4 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Chronic Low Back Pai n with DDD 5243 10% Low Back Strain 5237 10% 20050801
No Additional Conditions in Scope
 No Other VA Conditions in Scope
Combined: 10%
 Combined: 10%
Derived from VA Rating Decision (VA RD ) dated 200 50907 .


ANALYSIS SUMMARY:

Lumbar Spine Condition. Clinical notes in the service treatment record (STR) date an onset of chronic and recurrent low back pain (no precipitating injury) to 1996 and there is a 1997 physical therapy (PT) consult for back pain with an impression of disc disease. There are sporadic STR entries for this complaint afterwards, with increasing frequency starting in 2003. At that time the CI began a course of PT and later chiropractic treatment for the condition. Imaging revealed mild disc herniations and DDD; but multiple STR entries confirm the absence of radicular pain or neurological symptoms (with normal neurological exams) and neurosurgery opined that she was not a surgical candidate. There are various STR entries from the period preceding separation that commented on range-of-motion (ROM) and other ratable findings: a primary care (PC) entry from May 2004 (11 months prior to separation) commented on lumbar flexion to 90 degrees (normal); an orthopedic note from 15 September 2004 (7 months prior to separation) noted normal gait without spasm or tenderness (no ROM comment); a PC entry soon afterwards noted grossly “decreased” (no specificity) ROM in all planes with painful motion; a chiropractic entry a week later noted “full” ROM except limited left lateral flexion (painful motion all planes) and two chiropractic entries the following month noted tenderness and spasm (no ROM comment). There is additionally a PC entry from 28 January 2005, 10 weeks prior to separation and 4 months after the narrative summary (NARSUM), which documented grossly full ROM. There are no STR entries that documented significantly severe ROM impairment, abnormal neurological findings, gait disturbance, abnormal contour or other ratable findings (except the spasm, tenderness and painful motion noted above). The PEB referenced a 5-day period of prescribed bed rest (incapacitating episode) in January 2004, although the source evidence cannot be located in the STR.

The NARSUM was conducted on 24 September 2004 (7 months prior to separation) and, documented non-radiating lumbar pain (consistency and severity not elaborated) without neurological symptoms, which was exacerbated by prolonged standing, running, lifting (10 pound limit) and physical fitness activities. The physical examination did not comment on gait, spasm, or tenderness; but, noted “flexion to about 60 degrees” and documented painful motion in all other planes without documenting measurements. The commander’s statement reported that the CI “can work full shifts and is able to satisfy duty requirements,” although unable to deploy and satisfy physically demanding requirements; and, recommended retention with cross-training. A VA Compensation and Pension (C&P) examination was conducted on 1 August 2005 (4 months after separation) and documented constant pain rated 9/10 without radicular features, resulting in “limited mobility, quality of life minimized, no lifting.” The examiner also referenced 5 days of incapacitation over the preceding year. The VA physical exam documented a normal gait, tenderness without spasm and normal neurological findings. The VA measured ROM was flexion to 80 degrees and combined ROM of 230 degrees (normal 240 degrees) with painful motion.

The Board direct ed attention to its rating recommendation based on the above evidence. The PEB’s 10% rating under 5243 (intervertebral disc syndrome) was likely based on the VASRD §4.71a formula for incapacitating episodes; since, the 10% criterion under that formula was satisfied by the 5 days of incapacitation as noted above. The NARSUM flexion to 60 degrees ; however, would have met the 20% criterion under the §4.71a general spine formula. The VA ’s 10% ra ting under 5237 (lumbar strain [ not subject to rating for incapacitating episodes ] ) was consistent with the ROM evidence from the C&P and cited in the rating decision . The Board agreed that the rating under the general spine formula was indicated if it was concluded that the NARSUM flexion of 60 degrees was probative enough to carry a 20% recommendation. The NARSUM ROM evidence, however, is mitigated by several factors. The corroborative evidence from the STR does not support a conclusion that ROM was consistently compromised to the extent reflected by the 20% criteria. Specifically the Service evidence following the NARSUM is better aligned with the VA measurements, which were also more temporally proximate to separation than those of the NARSUM. It must also be considered that the C&P ROM evaluation is the only one in evidence in this case which complies with VASRD §4.46 (accurate measurement). The NARSUM reads as if flexion may have been estimated rather than measured (especially troublesome since 60 degrees is the threshold for a higher or lower rating), and measurement of remaining planes (a §4.46 requirement) was not accomplished. There was no evidence of ratable peripheral nerve impairment or documentation of incapacitating episodes in this case which would provide for additional or higher rating. 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 of the lumbar spine 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 lumbar spine 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 re-characterization of the CI’s disability and separation determination.


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20131022, 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-2013-02503.
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

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