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AF | PDBR | CY2014 | PD-2014-02479
Original file (PD-2014-02479.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXXXX       CASE: PD-2014-02479
BRANCH OF SERVICE: AIR FORCE     BOARD DATE: 20150320
SEPARATION DATE: 20041202


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Security Forces Journeyman) medically separated for a lumbar spine 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 temporary L4 profile and referred for a Medical Evaluation Board (MEB). The “chronic low back pain” was forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123. The MEB also identified and forwarded one other condition ( tobacco abuse) f or PEB adjudication. The Informal PEB adjudicated the lumbar spine condition as unfitting, rated 20%, referencing the Veterans Affairs Schedule for Rating Disabilities (VASRD). The remaining condition was determined to be C ategory III, ( not separately unfit and not compensable/ratable ) . 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 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 :

IPEB – Dated 20040816
 VA (~12 Mo. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Low Back Pain with Radiculopathy… 5243 20% Degenerative Changes ... Spine 5242 20% 20051129
Other x 1 (Tobacco Abuse, Not In Scope)
 Other x 0
RATING: 20%
 RATING: 20%
Derived from VA Rating Decision (VA RD ) dated 20 060109 (most proximate to date of separation [ DOS ] ) .





ANALYSIS SUMMARY:

Lumbar Spine Condition. The service treatment record (STR) documents an onset of back pain with a vehicular accident in January 2002, although there are also indications of back pain dating to a strain injury in Korea 2 years earlier. The pain persisted and was associated with bilateral radicular symptoms; magnetic resonance imaging (MRI) demonstrated bi-level disc protrusion (L4/5, L5/S1) with neural encroachment; and, surgical intervention ensued in September 2002. Radicular symptoms improved post-operatively, although some lower extremity radiation, sensory symptoms, and subjective weakness were reported. The back pain, however, rebounded post-operatively and was refractory to conservative management (which included narcotic analgesics and epidural steroid injection). A repeat MRI demonstrated post-surgical changes without recurrent disc protrusion or nerve compromise. There are several STR entries documenting normal strength and neurological findings, and none documenting objective extremity weakness. A neurosurgical consultant provided a detailed neurological examination demonstrating 5/5 lower extremity strength and normal reflexes, with the only deficit being minor sensory impairment “in an L5 dermatomal distribution.” There was no STR documentation of gait disturbance, significant range-of-motion (ROM) limitation, or incapacitating episodes.

The narrative summary (NARSUM) was conducted on 6 November 2003, with an addendum update of 31 July 2004 (4 months prior to separation). The examiner recorded “chronic 6/10 low back pain with some radiation down the right leg” with no elaboration of specific limitations other than limited ability to perform his job as a gate guard. The NARSUM physical exam documented lumbar tenderness and normal reflexes; without comment regarding gait, contour, spasm, or motor exam. There was no NARSUM documentation of formal ROM measurements, nor any service evidence of same in available records.

A VA Compensation and Pension (C&P) examination was conducted on 29 November 2005 (12 months after separation); and, documented constant back pain rated 3-4/10 with increasing severity from “walking two to three blocks,” “standing 10 to 15 minutes,” sitting, bending and lifting. Left leg radiation with “numbness and tingling,” but no subjective weakness, were reported. The VA physical exam documented a “slow” but normal gait; without comment regarding tenderness, spasm, or spinal contour. Neurologic findings were normal, with good strength and intact sensation. The VA measured ROM was 40 degrees flexion (normal 90 degrees) and combined ROM of 160 degrees (normal 240 degrees). Electrodiagnostic testing of the lower extremities was conducted by the VA 9 months after separation and was normal.

The Board directed attention to its rating recommendation based on the above evidence. The rationale for the PEB’s 20% rating under 5243 (intervertebral disc syndrome) is not explained; although, VASRD §4.71a criteria for a 20% rating are flexion in the range of 35-60 degrees or combined ROM less than 120 degrees (or, abnormal gait or contour). The VA’s 20% rating under 5242 (degenerative arthritis of the spine) cited the above C&P ROM measurements. Although service ROM measurements were not in evidence (possibly missing), there is no indication of ROM limitation more severe than the above 20% parameters. There was no documentation of incapacitating episodes which would achieve a higher rating under that formula. The Board considered whether an additional rating could be recommended under a peripheral nerve code for the associated radiculopathy in evidence 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 intermittently documented sensory component in this case has no functional implications, and no objective motor weakness is in evidence. There is thus no evidence of ratable functional impairment from the residual radiculopathy, and the Board cannot support a recommendation for an additional disability rating on this basis. 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 20140529, 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-2014-02479 .
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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