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AF | PDBR | CY2014 | PD 2014 00415
Original file (PD 2014 00415.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXX     CASE: PD-2014-00415
BRANCH OF SERVICE: AIR FORCE     BOARD DATE: 20140910
SEPARATION DATE: 20061122


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SSGT/E-5 (2A672/Aerospace Ground Equipment Craftsman) medically separated for a chronic low back pain (LBP) condition. The condition could not be adequately rehabilitated to meet the physical requirements of his Air Force Specialty or satisfy physical fitness standards. He was issued a P4 profile and referred for a Medical Evaluation Board (MEB). The LBP condition, characterized as “chronic back pain secondary to degenerative joint disease, intervertebral disc disease, facet disease,” 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 disc protrusions of T1 L-12 and L3-4,” as unfitting, rated at 20%, citing criteria of the Department of Defense Instruction (DoDI) 1332.39 and Veteran’s Affairs Schedule for Rating Disabilities (VASRD). The CI made no appeals and was medically separated.


CI CONTENTION: “My injuries were not evaluated correctly. I had a nerve block in my back before my evaluation.”


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 LBP 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 20061003
 VA - (4 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Low Back Pain 5243 20% DDD Lumbar Spine 5237-5243 20%* 20061116
Other x 0 (In Scope)
 Other x 8 20061116
Combined: 20%
 Combined: 20%
Derived from VA Rating Decision (VA RD ) dated 20070309 ( most proximate to date of separation ). Increased to 40% VARD 20110428.


ANALYSIS SUMMARY:

Low Back Pain Condition. The CI was first seen for LBP on 13 December 2004 when he reported a two week history of pain without antecedent trauma. His pain persisted despite conservative management. The magnetic resonance imaging taken on 10 January 2006 showed degenerative disc disease (DDD) at L3-4 and L4-5. Due to a serological marker suggestive of ankylosing spondylitis, a rheumatological evaluation was accomplished and this diagnosis excluded. The CI was advised to lose weight and was also treated with injections as well as ablation of the sensory nerves which carried the pain signal. Although these interventions provided the CI temporary relief from his symptoms, he was unable to return to full duty. He was not worldwide deployable and referred into the MEB process. The undated narrative summary (NARSUM) was dictated by his primary care physician and revealed on examination, that there was tenderness along the paraspinal muscles and decreased range-of-motion (ROM) secondary to pain. No specific comment was made regarding gait or spasm. On 15 August 2006 (3 months prior to separation and the VA examination), the CI had a nerve block but there is no record of additional blocks prior to the VA examination or separation. There was an earlier nerve block noted on 1 June 2006 and perhaps an ablation (nerve destruction) on 10 July 2006. The Board noted that the CI does not state when the nerve block was accomplished nor specify which evaluation followed it in his contention. Both ROM evaluations reviewed for determining the CI’s disability rating were completed after the above stated procedures were completed.

At the VA Compensation and Pension (C&P) examination (performed a week prior to separation) the CI reported DDD, joint disease of the spine (facet disease) and narrowing of the spinal canal (spinal stenosis.) He reported constant pain with radiation down both thighs. His posture and gait were normal. Tenderness of the paraspinal muscles was present, but there was neither spasm nor atrophy of the muscles. The neurological examination was normal as was heel-toe walk and tandem walk testing. In the below ROM chart; DeLuca criteria were not noted. The examiner did not comment on incapacitation, but stated that there was no “significant impairment to employment.” 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)		 MEB/PT ~ 2 Mo. Pre-Sep VA C&P ~ 1 Week. Pre -Sep
Flexion (90 Normal) 45 90
Combined (240) 1 5 0 180
Comment Paraspinal tenderness ; Lumbar spine m easurements rather than thoraco- lumbar Normal gait, posture, and neurological examinations
§4.71a Rating 20 % 10 %

The Board directed attention to its rating recommendation based on the above evidence. The PEB and VA both rated the LBP condition at 20% using the codes 5243 (intervertebral disc syndrome) and 5237 – 5243 (lumbosacral strain and intervertebral disc syndrome). The Board noted that the VA C&P examination was more complete and closer to separation therefore; they had a slightly higher probative value. The MEB examination supports a 20% rating adjudicated by the PEB; however, it only measured the lumbar ROM vice thoracolumbar, further reducing the probative value. The Board does note for the record that the MEB measurements are actually closer temporally to the nerve block than the significantly improved VA measurements. Nevertheless, the Board cannot recommend a rating lower than that adjudicated by the PEB. The Board considered the other coding options available for the back and none provided a route to a 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 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





                          
         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-2014-00415

         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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