RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01738
BRANCH OF SERVICE:  Air Force	SEPARATION DATE:  20090629

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E6, Avionics Sensor Systems Supervisor, medically separated for “chronic neck pain” and “chronic low back pain,” rated 10% and 10%, respectively, with a combined disability rating of 20%.

CI CONTENTION: The applicant makes no specific contention in their application.  The applicant’s complete submission is at Exhibit A.

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited to those conditions determined by the Physical Evaluation Board (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 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 Veterans Affairs Schedule for Rating Disabilities (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:

SERVICE PEB - 20081009	VARD - 20091211	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Neck Pain, w/ Mild Degenerative Disc Disease of C6-7	5243	10%	Cervical Spine Arthritis	5242	10%	20091026	
Chronic Low Back Pain	5299-5237	10%	Lumbago	5299-5237	10%	20091026	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:

Chronic Neck Pain.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s neck condition began in March 2006 after being thrown from a jet ski.  X-rays, no date provided, showed a mild degenerative disc disease at C6/7.  An MRI in January 2007 indicated a right lateral bulge at C5-6, and a right lateral disc/spur complex at C6-7 with mild central stenosis. There was no surgical indication.  Despite treatment, the cervical spine condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for MEB.  The MEB forwarded “cervicalgia HPN w/o myelopathy, cervical radiculopathy” for PEB adjudication.

At a pain center visit in July 2008, 11 months prior to separation the CI complained of continued neck pain that was dull and aching.  Physical examination noted no muscle weakness, and no numbness or tingling.

The MEB NARSUM, dated July 2008, 11 months prior to separation, indicated that the CI’s only option was continuation with pain management.  Physical examination noted a normal gait with “tenderness to palpation from neck to L-spine.”  There was “full” range of motion (ROM).  There were no sensory or motor deficits.   At a pain center visit in October 2008, 8 months prior to separation, the CI received his 3rd cervical transforaminal nerve root injection.  The CI indicated that the 2nd injection had produced 95% pain relief, the pain had decreased in sharpness, and that he was more functional since the last injection.

At the VA Compensation and Pension (C&P) examination in October 2008, performed 4 months after separation, the CI reported neck pain without radiation into the lower extremities, and said that the pain affects his activities of daily living because he has difficulty turning his head. Physical examination showed non-tenderness to palpation.  Neurologic examination was normal with no motor, reflex or sensory deficits [of note, a general VA examination provided a diagnosis of right carpal tunnel syndrome with complaints of numbness with examination finding of a positive Tinel’s test (wrist-level neuropathy)].  At the end of the VA examination the physician stated “With regards to the DeLuca provisions, the patient did have pain on range of motion testing today.”

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under the 5243 code (intervertebral disc syndrome), citing the VASRD.  The VA also assigned a 10% rating using the 5242 code (degenerative arthritis of the spine) based on the VA C&P examination 4 months after separation, citing “objective confirmation by a physician of painful or limited motion of an arthritic major joint or group of minor joints.”

The Board agreed that a 10% rating, but no higher, was justified for limitation of combined ROM (greater than 170 degrees but not greater than 335 degrees) or for tenderness reported on the MEB, examination.  The VA examination would rate no higher than 10% for conceded painful motion on repetition.  There was no muscle spasm or guarding severe enough to result in abnormal gait or spinal contour, thus the next higher 20% rating was not justified on this basis.

The Board considered whether a higher rating (§4.7) was achieved by using the alternate rating formula based on incapacitating episodes due to intervertebral disc syndrome. Although the CI had intervertebral disc disease there were no incapacitating episodes requiring bed rest prescribed by a physician to warrant consideration of rating under the alternate VASRD formula based on incapacitating episodes due to intervertebral disc syndrome.

There was no associated cervical radiculopathy for separate peripheral nerve rating.  While the CI may have experienced radiating pain from the neck condition, this is subsumed under the general spine rating criteria, which specifically states “with or without symptoms such as pain (whether or not it radiates).”  There was no objective evidence of a radiculopathy with functional impairments such as weakness with a direct impact on fitness that were separately functionally impairing for duty.  The Board therefore concluded that additional disability rating was not justified 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 for the neck condition.

Chronic Low Back Pain.  According to service treatment records and the MEB NARSUM, the CI’s back condition began “several years ago” without a specific cause.  He complained of pain over his right side.  A 3 level lumbar discography, no date provided, was negative for concordancy (linking pathology or test pressure to the CI’s symptoms).  An MRI in April 2008, 14 months prior to separation, was normal with no disc herniation or significant disc bulge.  Despite treatment, the back condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for MEB.  The MEB forwarded “lumbago” for PEB adjudication.  The NARSUM, written in July 2008, 11 months prior to separation, indicated that the CI’s only option was continuation with pain management.  Physical examination noted “full” ROM, intact gait, and no neurosensory or motor deficits noted.  There was “tenderness to palpation from neck to L-spine.”  At a pain center visit in November 2008, 7 months prior to separation, the CI complained of burning, aching and shooting pain.  Physical examination noted lumbar paraspinal tenderness with negative tingling, numbness, or leg weakness.  

At the VA C&P examination in October 2009, performed 4 months after separation, the CI reported his back pain started in 2005 shortly after the beginning of his hip pain; he did not use an assistive device, but had significant flare-ups of pain that affected his activities of daily living, and that he was unable to work because of the pain.  The CI had not been ordered on bed rest in the 12 months prior to the examination.  Physical examination showed mild right paraspinal tenderness, and negative straight leg raise (for radicular symptoms).  Neurologic examination was normal with no motor, reflex or sensory deficits.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under an analogous 5299-5237 code (lumbosacral strain), citing the VASRD.  The VA also assigned a 10% rating using an analogous 5299-5237 code based on the VA C&P examination 4 months after separation, citing “liberal interpretation of the documented paraspinal tenderness to palpation as a functional impairment associated with your lumbago, and assigned a 10 percent evaluation for the same.”

The Board agreed that a 10% rating, but no higher, was justified for limitation of flexion (greater than 60 degrees but not greater than 85 degrees) and/or combined ROM (greater than 120 degrees but not greater than 235 degrees), or tenderness reported on the MEB examination.  The VA examination would rate no higher than 10% for tenderness.  There was no muscle spasm or guarding severe enough to result in abnormal gait or spinal contour, thus the next higher 20% rating was not justified on this basis.  There was no documentation of intervertebral disc syndrome with incapacitating episodes which would provide for a higher rating under that formula or evidence of ratable peripheral nerve impairment which would provide for additional 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:  In the matter of the neck condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  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.  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 20140424, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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

Dear XXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2014-01738.

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,

Attachment:
Record of Proceedings