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AF | PDBR | CY2013 | PD-2013-02731

Original file (PD-2013-02731.rtf) Auto-classification: Denied

RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXX CASE: PD-2013-02731
BRANCH OF SERVICE: AIR FORCE BOARD DATE: 20140820

SEPARATION DATE: 20061222

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SrA/E-4 (3P051/Security Forces Journeyman) medically separated for a back condition. This condition could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty or satisfy physical fitness standards. She was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB). L4-L5 disc protrusion and small L5-S1 disc herniation was forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123. The MEB also identified and forwarded a headache condition. The Informal PEB adjudicated chronic low back pain (LBP) as unfitting, rated 20%, with application of the VA Schedule for Rating Disabilities (VASRD). The remaining condition w as determined to be a Category II condition ( one which can be unfitting , but is not currently compensable or ratable ) . The CI appealed to the Formal PEB (FPEB), which affirmed the PEB findings and rating. The CI made no appeals and was medically separated.

CI CONTENTION: “Because of injury had to have back surgery in 2012.”

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. The not unfitting headache condition was not contended; thus, it is not within the DoDI 6040.44 defined purview of the Board. This and any other condition or contention not requested in this application, remain eligible for future consideration by the Board for Correction of Military Records.

RATING COMPARISON :

Service FPEB – Dated 20061107	*VA - (26.9 Mo. Post-Separation)**
Condition	Code	Rating	Condition	Code	Rating	Exam
Chronic Low Back Pain	5243	20%	DDD, Lumbar Spine	5242	10%	20090309
Other x 1 (Not in Scope)	Other x 4 (Not in Scope)	+QA
Combined: 20%	Combined: 20%

*Derived from VA Rating Decision (VARD) dated 200 90324 (most proximate to date of separation (DOS))

ANALYSIS SUMMARY: The Board acknowledges the CI’s information regarding the significant impairment with which her service-connected conditions continue to burden her; but, must emphasize that the Disability Evaluation System has neither the role nor the authority to compensate members for anticipated future severity or potential complications of conditions resulting in medical separation. That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws.

Chronic Low Back Pain. The first record in evidence addressing the LBP condition was a neurology evaluation (for headaches) dated 9 August 2006, just over 4 months prior to separation. Her neurological examination and gait were normal. She was followed by pain management for her back pain with moderate control. However, a pain management note dated 2 weeks later on 23 August 2006, noted that she had LBP since 16 April 2004 and had not been seen since January 2005. Medications, including narcotics and physical therapy, provided little relief. It was noted that a magnetic resonance imaging (MRI) from May 2004 showed a disc protrusion at L4-5 and herniation at L5-S1. It was also noted that she had spinal stenosis. She was noted to have spasm and limited range-of-motion (ROM) with an antalgic (guarding against pain) gait. The neurological examination was normal. She was seen a week later for a nerve block with some decrease in her symptoms. At the MEB narrative summary (NARSUM) examination dated 5 September 2006, approximately 3 months prior to separation, the CI reported that her pain had begun while sitting in a car in April 2004. She reported that she had been evaluated by several neurosurgeons, but was not interested in surgery. These records are not in evidence. The examiner recorded that a second MRI, on 18 July 2005, noted no interval change at L5-S1, but some increase in the protrusion at L4-5. It was noted that she had epidural steroid injections (of the back nerves) eight times; the benefit was not recorded, but presumably, these were helpful if repeated more than once. On examination her gait and stance were normal. The ROM was noted to be “difficult,” but it was not recorded if it was limited or not. This nerve block was repeated on 27 September 2006 with, again, partial benefit. She was then seen on 18 October 2006 for ablation of the nerve branches. Review of the records shows that in the last year of service, the CI was on quarters for 19 days. However, the notes are not completely legible and the reason why she was on quarters is clear on only two notes (when she was placed on quarters for a total of 5 days). The FPEB did note that she had been on quarters for a total of 22 days, 10 of which were for the back condition. She could walk a block and used no assistive device.

There was not a VA Compensation and Pension (C&P) examination proximate to separation. The initial back C&P was dated 9 March 2009, over 26 months after separation. At that evaluation, the CI reported constant stiffness with flares of pain about once a month after lifting. She denied incapacitating episodes with physician prescribed bed rest; she had not been seen for the back condition for 2 years. On examination, her gait and contour were normal. There was no spasm or atrophy. The ROM was limited by stiffness and discomfort; it is charted below. DeLuca criteria were not present. The neurological examination was normal. The goniometric ROM evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.

Thoracolumbar ROM (Degrees)	NARSUM 3.6 Mo. Pre-Sep	PT 3.1 Mo. Pre-Sep	VA C&P 26 Mo. Post-Sep
Flexion (90 Normal)	Difficult w/ROM especially flexion	40	90
Combined (240)	“	165	200
Comment	--	Limited by pain	Limited by stiffness and discomfort
§4.71a Rating	-- %	20 %	10 %

invalid font number 31502 IAW §4.59 (Painful motion)

The Board directs attention to its rating recommendation based on the above evidence. The PEB rated the back condition at 20% using the code 5243 (intervertebral disc syndrome). The Board noted that the limitation in flexion supports a 20% rating as does the days of quarters (incapacitation) noted by the FPEB. The VA, relying on an examination over 2 years after separation, rated the back at 10% and used the code 5242 (degenerative arthritis). The Board considered the evidence in the records available for review and found no route to a rating higher than the 20% rating adjudicated by the PEB. 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 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 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 20131216, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record

XXXXXXXXXXXXXXX
President
Physical Disability Board of Review

SAF/MRB

Dear XXXXXXXXXXXXXXX:

         Reference your application submitted under the provisions of DoDI 6040.44 (Title 10 U.S.C. § 1554a), PDBR Case Number PD-2013-02731.

         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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AF | PDBR | CY2013 | PD-2013-02731

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