RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01273
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20070727

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Avionics Test Station and Components Journeyman, medically separated for mid back pain, with a disability rating of 20%

CI CONTENTION:  The CI made no specific contention.  The 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 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 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 – 20070521	VARD – N/A	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Mid-Back Pain	5237	20%	No VA Claim in Record	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  N/A	

ANALYSIS SUMMARY:  

Mid Back Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s back condition began in March of 2006 when he presented to the emergency room with the complaint of right upper quadrant abdominal pain, nausea, and vomiting.  The CI denied any specific injury or trauma.  Following a thorough evaluation by gastroenterology, on 26 April 2006 the examiner opined that the CI's right upper quadrant pain was a result of musculoskeletal dysfunction, in the right side of his thoracic spine.  The 8 August 2008 thoracic spine X-ray showed a mild chronic compression deformity of the left lateral T-7 vertebral body.  An 8 August 2006 thoracic spine diagnostic imaging (MRI) study showed mild T-4 to T-9 intervertebral disc space disease without neural foraminal (nerve root opening) narrowing.  The 4 September 2006 physical therapy (PT) exam documented that cervical and lumbar spine range of motion (ROM) was full.  The straight leg raise ([SLR] assess for herniated disc causing sciatic nerve root [L5-S1] radiculopathy) and slump (assesses for herniated disc causing sciatic nerve root [L5-S1] radiculopathy) tests were negative.  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 “chronic middle back pain” for PEB adjudication.  On 28 February 2007 PT measured repetitive (X3) range of motion (ROM) for the MEB.  The pain-limited thoracic spine ROM values were flexion of 40/40/40, extension of 20/20/20, right lateral flexion of 30/30/30, left lateral flexion of 20/20/20, and bilateral rotation of 40/40/40, and combined of 190/190/190 degrees.  The 1 March 2007 MEB NARSUM examination, 5 months prior to separation, noted complaints of chronic back pain without much improvement, and inability to participate in physical training.  The physical examination documented “Back shows tenderness, limited mostly to the T-spine area on the patient's right side, as well as limited range of motion.”  The examiner referred to the PT ROM for MEB measurements.   

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the mid back condition 20%, coded 5237 (lumbosacral strain) citing chronic mid-back pain.  No VA claim was filed, and there is no VA rating to compare.  The 4 September 2006 PT examination reported that lumbar spine ROM was full.  The 28 February 2007 PT for MEB examination reported average thoracic spine flexion of 40 and combined ROM of 190 degrees.  The Board noted the examiners did not provide the integrated thoracolumbar spine ROM as is the current practice under the VASRD guidelines.  The 10% rating would require flexion of greater than 60 degrees but not greater than 85 degrees; or a combined ROM of greater than 120 degrees but not greater than 235 degrees of the thoracolumbar spine.  The 20% rating would require flexion of greater than 30 degrees but not greater than 60 degrees; or a combined ROM of not greater than 120 degrees of the thoracolumbar spine.  The Board concluded there was no evidence to support a rating higher than the rating adjudicated by the PEB.  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).  There was no evidence of an associated unfitting radiculopathy for consideration of a separate peripheral nerve 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 thoracic condition.  

BOARD FINDINGS:  In the matter of the mid 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 20150612, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAF/MRB

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

	Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2015-01273.

	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,