RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXX	CASE:  PD-2014-01948
BRANCH OF SERVICE:  AIR FORCE	BOARD DATE:  20140918
SEPARATION DATE:  20070921

SUMMARY OF CASE:  The available evidence of record reflects that this covered individual (CI) was an active duty SSgt/E-5 (4A151/Medical Materiel Journeyman) medically separated for chronic mid-back pain.  The condition could not be adequately rehabilitated to meet the requirements of her Air Force Specialty or physical fitness standards, so she was issued a P4 temporary profile and referred for a Medical Evaluation Board (MEB).  The back condition, characterized as “chronic back pain,” was forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated the back pain as unfitting, rated 10%.  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 back condition is addressed below; 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 20070802	VA - (~2 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Midback Pain, w/ Loss of Vertebral Height	5299-5235	10%	Post Traumatic Degenerative Joint Disease of the Dorsal Spine w/ Chronic Pain Syndrome	5242	10%	20071113	
Other x 0 (Not in Scope)	Other x 9	 20071113	
Rated:  10%	Combined:  60%	
Derived from VA Rating Decision (VARD) dated 20080430

ANALYSIS SUMMARY:

Chronic Back Pain Condition.  Although the CI recovered from a thoracic spine vertebral compression fracture prior to service entry, she developed mid back pain in 2005 that (according to the available service records) was not a consequence of concurrent injury.  Radiographic evaluation for persistent pain revealed old minimal vertebral compression fractures of T7 and T9 and minimal multilevel disc protrusions.  The CI’s 1-year tour (beginning in 2006) to Korea was ended after 3 months due to exacerbation of the back condition from wearing individual protective equipment.  Physical therapy, pain medications and injections could not sufficiently relieve the CI’s ongoing pain.

At an orthopedic evaluation on 30 April 2007 (5 months prior to separation) the CI reported that her pain stemmed from constantly lifting at work; it was worse with exercise, turning, and the pain interrupted her sleep.  Examination documented that the CI did not appear uncomfortable; appearance of the spine was normal, but tenderness and painful motion were present.  The examiner further noted “Full range of motion was present except for rotation and side bending.”

The commander’s statement dated 7 June 2007 (4 months prior to separation) reported that the CI was unable to perform non-administrative duties; and a physician directed that she miss two duty days during the prior 3 months due to her back condition.  The narrative summary dated 11 June 2007 reported a normal gait.  At the MEB examination for range-of-motion (ROM) dated 23 July 2007 (2 months prior to separation), paraspinal muscle spasms were reported, but comments of spinal contour and gait were omitted.

At the VA Compensation and Pension (C&P) examination dated 13 November 2007 (2 months after separation), the CI reported that pain began after falling onto her back while lifting [items] in a warehouse in August 2005.  Back pain was constant, with flares caused by movement, bending or lifting.  Medication could alleviate the pain.  She reported no difficulty with walking, and did not use assistive devices.  Examination showed no tenderness or spasms, and normal gait and spinal contour.  ROM testing was repeated ten times without additional limitation; painful motion was absent although “tightness” during ROM was reported.  Physician-prescribed bed rest during the previous year was denied.  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 ~ 2 Mos. Pre-Sep	VA C&P ~ 2 Mos. Post-Sep	
Flexion (90 Normal)	80 (77,78,80) 	90	
Combined (240)	215	240	
Comment	+Tenderness, painful motion, spasm		
§4.71a Rating	10%	0% or 10% (VA 10%)	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under an analogous code 5235 (vertebral fracture or dislocation), while the VA also assigned a 10% rating under the code 5242 (degenerative arthritis of the spine).  The Board agreed that the ROMs by the MEB examiner supported a 10% rating, but no higher.  There was no evidence of muscle spasms or guarding severe enough to result in an abnormal gait or abnormal spinal contour, and therefore the next higher 20% rating was not justified.  The Board also considered rating intervertebral disc disease under the alternative formula for incapacitating episodes, but could not find sufficient evidence which would meet a minimal rating under that formula.  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 chronic mid-back pain 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.  In the matter of the chronic mid-back pain 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 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 20140502, 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-2014-01948

	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