RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00188
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20060801

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Financial Management and Comptroller, medically separated for “mid back (thoracic) pain” with a disability rating of 0%.

CI CONTENTION:  The CI requested consideration of all conditions.  The CI’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 based upon a 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 - 20060502	VARD - 20071023	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Mid Back (Thoracic) Pain…	5299-5237	0%	Back Condition	5237	0%	20070501	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Mid Back (Thoracic) Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s mid back (thoracic) pain condition began in June 2005.  The CI denied any specific injury or trauma.  Imaging studies (X-ray) in June and August 2005 showed a normal thoracic spine with normal alignment, the disc spaces and vertebral bodies were well preserved with no evidence of fracture.  Magnetic resonance imaging from 1 September 2005 indicated a Schmorl’s node (disc(s) bulging into the adjacent vertebral body, usually inherited or degenerative– may or may not be symptomatic) at T6-7 and T7-8 and was interpreted by the radiologist as an “essentially negative study.  There was no surgical indication, and conservative treatment, including myofascial trigger point injections, did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “persistent complaints of thoracic back pain” for PEB adjudication.

During the MEB NARSUM examination 21 March 2006, 4 months prior to separation, the CI reported mid back pain.  The pain prevented him from performing sit-ups, cycling, pushups, or running.  Physical examination showed a normal gait and there was no tenderness to palpation of the mid-back.  There was full ROM with associated pain.  

At the 1 May 2007 VA Compensation and Pension (C&P) Spine evaluation, performed 9 months after separation, the CI reported constant, daily mid back pain, described as dull to a sharp pain.  The CI reported flare-ups every 2 to 3 weeks, lasting hours.  The pain was aggravated by sitting or standing for long periods.  The pain was relieved by physical therapy and medication (Ibuprofen, Vicodin, and naproxen).  Physical examination showed normal gait and posture with no guarding or spasms.  There was tenderness bilaterally and the thoracolumbar ROM was normal with associated pain.  Lower extremity strength, sensation, and reflexes were normal.  Thoracic and lumbar spine X-rays were normal.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the mid back (thoracic) pain condition 0%, coded 5299-5237 (analogous to lumbar spine strain), citing normal examination and radiological imaging.  The VA also rated the mid back (thoracic) pain condition 0% coded 5237 (lumbar spine strain), based on the VA C&P examination 8 months  after separation, citing forward flexion of the thoracolumbar spine of greater than 85 degrees, or, combined range of motion of the thoracolumbar spine greater than 235 degrees. 

There was no limitation of thoracolumbar spine motion to support a minimum rating under the General Rating Formula for Diseases and Injuries of the Spine, however the MEB NARSUM and VA examinations noted the presence of painful motion and the C&P examination noted tenderness.  A 10% rating was therefore supported.  There was no muscle spasm or guarding severe enough to result in an 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 (IVDS) with incapacitating episodes which would provide for a higher rating under that formula (for IVDS), 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 recommends a disability rating of 10% for the mid back pain condition, coded 5299-5237.

BOARD FINDINGS:  In the matter of the mid back (thoracic) pain condition, the Board unanimously recommends a disability rating of 10%, coded 5299-5237 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.  

The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Mid Back (Thoracic) Pain	5299-5237	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150226, 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-2015-00188.

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 not appropriate under the guidelines of the Veterans Affairs Schedule for Rating Disabilities.  Accordingly, the Board recommended modification of your assigned disability rating without re-characterization of your separation with severance pay. 

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding, accept their recommendation and direct that your records be corrected as set forth in the attached copy of a Memorandum for the Chief of Staff, United States Air Force.  The office responsible for making the correction will inform you when your records have been changed.

Sincerely,

Attachments:
1.  Directive
2.  Record of Proceedings

cc:
SAF/MRBR