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AF | PDBR | CY2014 | PD 2014 03102
Original file (PD 2014 03102.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXX     CASE: PD-2014-03102
BRANCH OF SERVICE: AIR FORCE     BOARD DATE: 20141114
SEPARATION DATE: 20081021


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SSgt/E-5 (2A5/Aircraft Maintenance Craftsman) medically separated for chronic low back pain (LBP). The back condition could not be adequately rehabilitated to meet the physical requirements of his Air Force Specialty. He was issued a temporary L4 profile and referred for a Medical Evaluation Board (MEB). The low back condition, characterized as “chronic low back pain due to severe degenerative at L4-5 and L5-S1” and “status post (s/p) 360 degree L4-5 and L5-S1 fusion operation,” were 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 status post fusion of L4-S1” as unfitting, rated at 20%, citing the Veterans Affairs Schedule for Rating Disabilities (VASRD). The CI made no appeals and was medically separated.


CI CONTENTION: “Please consider all conditions.”


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 chronic low back pain 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 20080731
 VA - (3.3 Mos. Pre-Separation)
Condition
 Code Rating Condition Code Rating Exam
Chronic Low Back Pain Status Post Fusion of L4-S1 5241 20% Chronic Thoracolumbar Strain (Claimed as Degenerative Disc Disease) 5237 20% 20080714
Sciatica, Left Lower Extremity (Claimed as Radiculopathy, Left Lower Extremity) 8520 10%
Sciatica, Right Lower Extremity (Claimed as Radiculopathy, Right Lower Extremity) 8520 10%
Status Post Lumbar Spine Disc Fusion L4-5 and L5-Sl with
Scars		 7805 0%
Other x 0 (Not in Scope)
 Other x 2
Combined: 20%
 Combined: 50%
Derived from VA Rating Decision (VA RD ) dated 200 81126 ( most proximate to date of separation)



ANALYSIS SUMMARY:

Low Back Pain Condition. The CI had onset of low back pain with burning pain in both lower extremities in October 2004. A magnetic resonance imaging of the lower back on 6 May 2005 revealed degenerative disease of the spine and discs in the lower spine with some compression of the spinal nerves. A study with injection of dye directly into the spine area (spinal disc-o-gram) performed on 5 May 2006, reproduced the CI’s back pain and demonstrated severe degenerative disc disease. Back surgery was performed on 6 March 2007. This consisted of removal of the discs, partial laminectomies and stabilization of the lower spine in the front (anterior) and back (posterior) with screws, metal plates and bone grafts. Intraoperative nerve conduction studies revealed no injury to the spinal nerves during the procedure. Post-operatively the CI healed well and underwent a second surgery in early October 2007 for removal of the anterior back plates. The CI was placed on post-operative convalescent leave after this surgery from 12 October 2007 until 15 November 2007. On orthopedic evaluation performed on 17 April 2008, neurologic symptoms were reported to be improved but back pain persisted. On physical therapy (PT) exam for the MEB performed on 12 May 2008, range-of-motion (ROM) of the back was forward flexion of 40 degrees and extension of 10 degrees with painful motion. (Normal: 90 degrees and 30 degrees respectively). Sensation, reflexes and motor strength in both lower extremities were normal. On exam 8 May 2008, the CI reported he was “pain free” and gait and stance were described as “normal.”

At the MEB narrative summary evaluation performed on 12 May 2008 (5 months prior to separation), results of the 1 May 2008 PT exam, detailed above, were referenced, and are reproduced in the chart below. On pain management evaluation performed on 13 May 2008, the CI reported “excellent relief of the nerve pain symptoms in his legs from medication.”

At the VA Compensation and Pension exam (performed approximately 3 months prior to separation), the CI reported continued pain and numbness in both lower legs. He was working as an aircraft mechanic and reported “no functional impairment from the condition.” The CI claimed 34 days of bed rest incapacitation in October 2007, ordered by his operating surgeon. On examination the CI was in no distress. Gait, posture and curvature of the spine were normal. Surgical scars were healed, non-tender and without ulceration or instability. The remaining findings on the back exam are detailed below.

The goniometric active ROM evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized below:

Thoracolumbar A ROM
(Degrees)		 MEB 5 Mo. Pre-Sep
(20080512)
VA C&P 3 Mo. Pre-Sep
(20080714 )
Flexion (90 Normal) 40 60
Extension (30) 10 25 (26)
Combined (240) 105 2 05
Comment Normal m otor strength in both legs normal l Posture/gait normal; No radiating pain on movement; no back spasm, no ankylosis. No signs of nerve root involvement.

The Board directed attention to its rating recommendation based on the above evidence. 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. The Board unanimously agreed that the record in evidence supported a rating of 20%, but no higher, for the back condition using range of motion criteria. The Board then reviewed other avenues for appropriate rating. The Board agreed there was no evidence for ratable peripheral nerve impairment in this case, since no motor weakness was present, sensory symptoms were improving and had no functional implication and radiating leg pain was subsumed under the back rating IAW §4.71a. The Board considered a rating under code 5243, (incapacitating episodes/intervertebral disc syndrome). An incapacitating episode is defined as a period of acute signs and symptoms due to intervertebral disc syndrome that requires bed rest prescribed and treated by a physician. Under this definition a 20% rating requires incapacitating episodes having a total duration of at least 2 weeks, but less than 4 weeks, during the past 12 months. The next higher rating, 40%, requires incapacitating episodes having a total duration of at least 4 weeks, but less than 6 weeks during the last 12 months. The Board noted the report of the CI of being placed on bed rest for 34 days in October 2007; approximately 5 weeks. The Board unanimously opined that this was ‘convalescent leave’ required after the second back operation to remove the spinal hardware in October 2007 and reflected a period for healing rather than the severity of the condition. The Board found no episodes of incapacitation in the year period prior to separation. The Board agreed that the record in evidence supported no rating under this code. The Board unanimously agreed that the record in evidence did not support a compensable rating for scars, code 7804, as surgical scars were well healed, non-tender and not irritated. The Board found no other appropriate codes for consideration. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded 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 20140609, 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-2014-03102.
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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