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AF | PDBR | CY2014 | PD-2014-00044
Original file (PD-2014-00044.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXXXX        CASE: PD -2014 -00044              
BRANCH OF SERVICE: AIR FORCE      BOARD DATE: 201 5 0701
Separation Date: 20070302


SUMMARY OF CASE : Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Utilities System Journeyman) medically separated for a lumbosacral spine condition. The condition could not be adequately rehabilitated to meet the physical requirements of his Air Force Specialty (AFS) or satisfy physical fitness standards. He was issued a n L4 profile and referred for a Medical Evaluation Board (MEB). The “low back pain (LBP)” was forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123. No other condition was submitted by the MEB. The Informal PEB adjudicated “chronic LBP with spondylosis and discogenic change at L5-S1” as unfitting, rated 10% citing application of the DODI and Veterans Affairs Schedule for Rating Disabilities (VASRD). The CI made no appeals and was medically separated.


CI CONTENTION : “I was found medically unfit and I feel that I should of [ sic ] gotten a medical retirement when getting cut. I am no longer able to work partly because of my back and I was not able to do plumbing work like I was trained to do. I can no longer physically do the kind of work that I did prior to my injury.”


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 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 :
invalid font number 31502
IPEB – Dated 20070116
 VA* - (~3 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Chronic LBP, w/Spondylosis … 5242 10% Degenerative Disc Disease(DDD) Lumbar Spine w/Herniated Disc 5243 10% 20070615
Left Lower Extremity Lumbar Neuritis 8520 10% 20070615
Other x 0 (Not In Scope)
 Other x 3 (Not in Scope)
RATING: 10%
 RATING: 20%
*Derived from VA Rating Decision (VARD) dated 20070807 (most proximate to date of separation (DOS)).

ANALYSIS SUMMARY :

Back Condition . The CI reported a 2-to- 3 yea r history of atraumatic LBP with pain and numbness that radiated to the left leg , which worsen ed in 2006. The lumbar spine magnetic resonance imaging ( MRI ) performed in May 2006 demonstrated spondylosis , a herniated disc and a tear at L5-S1. An electromyogram (EMG) in July 2006 demonstrate d a non-specific chronic lumbosacral radiculopathy. A series of epidural steroid injections were recommend by a neurology specialist, but the CI declined. The MEB Narrative Summary (NARSUM) exam approximately 3 months prior to separation documented that the CI had sharp LBP with radicular pain that radiated down the left leg to his heel. The pain was worsened by lifting, standing and sitting. The examiner stated that “his NCV (nerve conduction)/EMG studies were unremarkable.” Exam documented a normal gait and “ lumbosacral spine motion was normal ” with pain elicited on motion. There was no tenderness and straight-leg raising test ( SLR; radicular signs) was negative. There were no sensory abnormalities, motor weakness or abnormal reflex testing. The examiner stated “No peripheral neuropathy was noted.” Physical therapy range-of-motion (ROM) testing 2 t wo weeks following the NARSUM documented painful motion with forward flexion of 90 degrees (normal 90) and combined ROM of 240 degrees (normal 240).

The VA Compensation and Pension (C&P) exam approximately 4 months after separation documented that the CI had low back stiffness all day with pain that occurred 3 times daily and lasted for 2 to 3 hours. The pain was rated at 4-8/10 ; burning , sharp and numbness made worse by prolonged standing or siting. The CI also described sharp pain that radiated up to the mid back and down the left leg to the foot . The exam documented a normal gait with no back spasm or tenderness. SLR was negative and ROM was forward flexion of 90 degrees (normal ) with pain at 90 degrees and combined ROM of 240 degrees (normal). Although there was additional pain on repetitive testing there was no change in ROM. The examiner stated “there are no signs of intervertebral disc syndrome wi th chronic and permanent nerve r oot involvement.” Left lower extremity exam documented norma l motor function and reflexes. On the exam for a history of a fractured left ankle , there was decreased sensation in the left foot to light and sharp touch .

The Board directed attention to its rating recommendation based on the above evidence. The PEB coded the chronic LBP condition as 5242 ( Degenerative arthritis of the spine ) and rated at 10%. The VA coded the back condition as 5243 ( Intervertebral disc syndrome ) and rated at 10%. The General Rating Formula for Diseases and Injuries of the Spine considers the CI’s pain symptoms “with or without symptoms such as pain (whether or not it radiates), stiffness or aching in the area of the spine affected by residuals of injury or disease . ” The exams proximate to sep a ration did not document limitation of ROM, but both exams documented painful motion which would warrant a 10% rating IAW VASRD §4.59 (painful motion) . There was no documented muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour , and no incapacitating episodes to justify any 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 .

The Board considered whether additional Service rating could be recommended under a peripheral nerve code, as conferred by the VA, for the associated sciatic radiculopathy at separation. Firm Board precedence requires a functional impairment linked to fitness to support a recommendation for addition of a peripheral nerve rating to disability in spine cases. The pain component of a radiculopathy is subsumed under the general spine rating as specified in §4.71a. The sensory component in this case has no functional implications, and no motor weakness was in evidence. There is thus no evidence of a separately ratable functional impairment (with fitness implications) from the residual radiculopathy; and, the Board cannot support a recommendation for an additional disability rating on this basis.


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 chronic LBP 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 20131219 w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans Affairs Treatment Record




XXXXXXXXXXXXXXXXXXXX
President
Physical Disability Board of Review
        


SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD 20762

Dear XXXXXXXXXXXXXXXXXXXX :

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2014-00044 .

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,







XXXXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings

cc:
SAF/MRBR

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