RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00973
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20030905

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Integrated Avionics Systems Electronic Warfare Technician, medically separated for “cervical and thoracic spine pain, chronic” with a disability rating of 10%.  

CI CONTENTION:  “Review all conditions.”  The 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 - 20030616	VARD - 20040617	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Cervical and Thoracic Spine Pain, Chronic	5291	10%	Rhomboid Strain With Scoliosis Claimed as Mechanical
Thoracic Para Vertebral Muscular Pain	5237	10%	20040308	
			Cervical Strain Claimed as Chronic Cervical Algia	5237	10%		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Cervical and Thoracic Spine pain, chronic.  According to service treatment record and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s painful spine condition occurred in late 2000 after lifting heavy laundry bags while in basic training.  Initially he developed mid to upper back pain and received minimal relief from physical therapy (PT).  Over the next 2 years his thoracic back pain appeared to wax and wane while he underwent conservative treatment modalities.  During this interval, he also developed neck pain.   Secondary to two motor vehicle accidents (June 2001 and December 2002), the CI developed acute worsening of non-radicular neck pain and again continued on a non-surgical conservative treatment plan.  Initial and repeat radiographic imaging of the neck and thoracic spine remained normal.  Both, Neurology and Orthopedic consultations diagnosed neck and upper back musculoskeletal pain with no clinical signs of radiculopathy or myopathy and chronic myofascial pain triggered by mechanical lifting, respectively.  Despite long-term non-surgical treatment to include medication, restrictions, PT, and manipulations, the spine condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred to an MEB.  The MEB forwarded “chronic and recurrent mechanical cervicalgia and thoracic spine pain” for PEB adjudication.  At the 10 January 2003 MEB NARSUM examination, 8 months prior to separation, the CI reported as being, “…always in at least mild discomfort” with regards to neck pain.  His physical examination (PE) documented “good” cervical range of motion (ROM) without cervical boney or muscle tenderness.  There was no comment with regards to the thoracic portion of the spine.  All extremities were neurologically intact.

At the 8 March 2004 VA Compensation and Pension evaluation, 6 months after separation, the CI reported constant 7/10 mid-back pain described as burning, aching, sharp, and cramping in nature that travels up to the neck; aggravated by physical activities and relieved with prescription medication.  He endorsed the ability to function with medication.  The VA separately commented on the neck pain condition using the exact same verbiage as for the previously mentioned mid-back pain condition excepting that the neck pain traveled to the shoulders and was additionally caused by stress.  His VA PE revealed decreased and painful motion of the cervical spine noting the following ROM measurements: right and left lateral flexion of 30 degrees (normal 45 each direction), right and left rotation of 30 degrees (normal 80 each direction), extension of 20 degrees (normal 45), and forward flexion was normal at 45 degrees.  There was tenderness over C-5 vertebral level.  The upper extremities did reveal sensory deficits in 2-4 fingertips that was not attributed to any cervical pathology, but rather a peripheral nerve entrapment known as carpal tunnel syndrome.  

There was no isolated evaluation of thoracic spine ROM, but rather that of the combined unit of the thoracic and lumbar (thoracolumbar) spine motion which was normal.  However, tenderness was present over the muscles adjacent to the thoracic spine and spasm was present over the right rhomboid muscle (muscle between the upper thoracic vertebra and the medial [inside] portion of the shoulder blade).       

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the back condition under VASRD interim spine rules at 10% coded 5291 (limitation of motion of the dorsal spine); whereas, the VA rated the back condition under the new VASRD spine rating rules at a combined 20% coded 5237 (lumbosacral or cervical strain), based on the VA C&P examination 6 months after separation, citing ROM criteria.  In accordance with DoDI 6040.44, the panel is required to recommend an impairment rating IAW the VASRD guidelines in effect at the time of separation.  Although the PEB titled the overall spine condition into cervical and thoracic components,  panel members first deliberated and agreed that the majority of clinical encounters contained within the case file referred more often to the upper back as the primary and unrelenting condition and that the non-traumatic onset of initial neck pain was not considered a separate unfitting condition, but rather a subsumed condition under the thoracic back pain noting muscular tenderness involving areas overwhelmingly covering the upper back and shoulders.

Despite normal ROM of the combined thoracic and lumbar spinal segments on the more probative VA examination, panel members also agreed that the additional evidence of muscular spasm and tenderness over the upper thoracic spine not resulting in an abnormal spinal contour indeed supported a rating no greater than 10%.  After due deliberation, and considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was no objective support for an impairment rating greater than the PEB’s current 10% and therefore, there was insufficient cause to recommend a change in the PEB adjudication for the spinal pain condition. 

BOARD FINDINGS:  In the matter of the cervical/thoracic pain condition and IAW VASRD §4.71a, the panel 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 modification or re-characterization of the CI’s disability and separation determination 

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150608, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C. Department of Veterans Affairs Treatment Record

SAF/MRB

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Dear XXXXXXXXXXXXXXXXXX

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2015-00973.

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,