RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00323
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20060714

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5; Computer, Network, Switching & Cryptography Craftsman; medically separated for “thoracic and low back pain” with a disability rating of 10%.  

CI CONTENTION:  The CI contends his conditions that were determined to be not unfitting should also have received a disability rating.  The CI’s complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The panel’s scope of review is defined in DoDI 6040.44.  It is limited to review of disability ratings assigned 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 or non-compensable.  Any conditions outside the panel’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 panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The panel’s assessment of the PEB rating determination is based on 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(s) at the time of separation.  The panel 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 panel 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 - 20060525	VARD - 20070214	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Thoracic & Low Back Pain…	5243	10%	Lower & Thoracic Spine…DDD	5243	10%	20061227	
Narcolepsy	Cat II	Narcolepsy	8911-8108	10%		
Chronic Sinusitis		Chronic Sinusitis	6513	10%		
Gastroesophageal Reflux Disease		GERD	7346	10%		
Hypertension		Hypertension	7101	10%		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Thoracic & Low Back Pain.  According to the service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s back condition began in as early as 2001 after heavy lifting.  Radiographic studies in October 2004 showed two minimal compression deformities at the T7 vertebra (mid-back) of indeterminate age.  Further studies in November 2005 revealed bulges at two levels of intervertebral discs in the lower back (L4-5, L5-S1) with nerve root impingement evident on the lower disc nerve root on the right and possible minimal impingement on the right side of the upper disc.  There was no surgical indication, and conservative treatment did not result in improvement sufficient to allow unrestricted duty.  

At the time of the neurology clinic appointment on 16 August 2005, 11 months prior to separation, the CI reported low back pain that radiated into his right leg, which he was treating with a muscle relaxant (Flexeril).  On examination, the thoracic spine examination and ROM were normal.  The lumbar spine was moderately tender, and ROM was recorded as flexion 75 degrees (normal 90) with pain, extension 25 degrees (normal 30) and right and left lateral flexion each 25 degrees (normal 30).  No rotation ROM was recorded.   Neurologic examination was normal, as were gait and station.  

At the time of the physical therapy appointment on 16 February 2006, 5 months prior to separation, the CI reported low back pain that radiated into the right buttock and posterior thigh.  Physical examination recorded ROM and strength as within functional limits.  

At the 27 December 2006 VA Compensation and Pension (C&P) evaluation, 5 months after separation, the CI reported daily low back that radiated down the right leg into the foot.  This pain was exacerbated by lifting more than 25 pounds or excessive bending or standing, with flare-ups lasting 3-5 days and treated with heat and ice, muscle relaxants, or steroids.  He had reportedly been prescribed a back brace but had stopped using it, and was able to walk 1/2 mile or 30 minutes before the back pain started to bother him.  The physical examination showed an antalgic gait that was attributed to injuries in his left knee and ankle as well as the back pain.  Posture was described as slightly kyphotic (hunchback), along with slightly decreased normal curvature of the lower back.  Tenderness of the lower spine was present, and spasm was absent.  ROM was recorded as flexion 85 degrees (normal 90) and combined ROM at 150 degrees (normal 240).  Repetitive ROM resulted in increased pain and weakness.  Provocative testing for nerve root impingement was negative for radiculopathy.  Neurologic examination was normal.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the thoracic and low back pain 10%, coded 5243 (intervertebral disc syndrome), citing full range of motion and paraspinal tenderness.  The VA also rated the back condition 10%, coded 5243 (intervertebral disc syndrome), based on the C&P examination 5 months after separation, citing achievable ranges of motion and the pain component.  The panel agreed that a 10% rating, but no higher, was justified for limitation of flexion (greater than 60 degrees but not greater than 85 degrees) as recorded at the neurology and C&P examinations, and/or combined ROM (greater than 120 degrees but not greater than 235 degrees) reported on the VA examination.  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 evidence of intervertebral disc syndrome (IVDS) which resulted in incapacitating episodes requiring physician-prescribed bed rest to warrant consideration of rating under the alternate VASRD formula (for IVDS).  

After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the thoracic and low back pain.  

Contended PEB Conditions:  Narcolepsy, Chronic Sinusitis, Gastroesophageal Reflux Disease (GERD), and Hypertension.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  The PEB remarks cited above indicated likely overall effect IAW DoDI 1332.38, E3.P3.4.4, and the diagnoses and remarks clearly indicated that none of the conditions were unfitting.  None of the conditions were implicated in the commander’s statement.  The profile was L4 and did not list any diagnoses.  Only narcolepsy was noted on the MEB as failing retention standards.  All of the conditions except for hypertension were noted as “currently under control,” or “currently under good control” in the NARSUM.  Hypertension was considered likely due to medications and anti-hypertensives therapy was being evaluated.  There was no performance-based evidence from the record that any of the conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the thoracic & low back pain condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the contended narcolepsy, chronic sinusitis, gastroesophageal reflux disease, and hypertension conditions, the panel unanimously recommends no change from the PEB determinations as not unfitting.  There were no other conditions within the panel’s scope of review for consideration.  The panel, therefore, recommends that there be no modification or re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150521, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2015-00323.

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,

XXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings