RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02231
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20071210

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Aerospace Medical Service Craftsman, medically separated for “chronic low back pain, with disc protrusion of T7-8” with a disability rating of 10%.

CI CONTENTION:  “I was suffering from PTSD which Dr. Jones my Psychiatrist failed to recognize.  I was also addicted to Percocet.  I was prescribed 5/325 mg taking 5x daily for back pain, by pain management Dr. Reddy.  I was on this medication for several years.  I feel that I wasn’t competent at the time when I had to decide between separation pay or TDRL.  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 - 20071016	VARD -20131203	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain…	5243	10%	Herniated Thoracic Disc T7-T8	5243	10%	20130912	
			Lumbar Spine Condition	5237	NSC	20130912	
Major Depressive Disorder (MDD)	9434	Cat II	PTSD with MDD	9434-3411	70%	20131115	
Pain Disorder…	9422	Cat II					
Migraines	8100	Cat II	Migraines	8100	10%	20130912	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  80%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain (LBP) with Disc Protrusion of T7-8.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s chronic low back pain began in 2001 after lifting a patient.  She noted increasing pain in 2003 associated with numbness of the right leg.  MRI of the thoracic spine on 5 September 2003 showed a central disc herniation at T7-8 with mild flattening of the thoracic cord.  MRI of the lumbar spine 1 month later on 17 October 2003 was normal as was a repeat MRI on 19 October 2004.  She was evaluated in neurosurgery on 6 January 2005.  The neurological examination was normal and the source of her pain was unclear.  She was seen periodically for the LBP over the next year.  Repeat MRI of the thoracic spine on 30 March 2006 was essentially unchanged from the examination in September 2003.  It was noted in primary care a few days later than she would require an MEB.  Motion of the back on 9 May 2006, 19 months prior to separation, was limited to 60 degrees flexion (normal is 90 or greater) and extension of 15 degrees (normal is 30 or greater).  Spasm was present.  An X-ray of the thoracic spine on 25 September 2006 showed a mild curve to the right (scoliosis).  In neurosurgery on 12 October 2006, the CI was noted to have a normal neurological examination.  Neither tenderness nor spasm were present.  Provocative testing for nerve root irritation was negative.  Her pain was thought to be multifactorial including a 50 pound weight gain, poor posture, no exercise, large breasts, and depression.  She did not have a surgical lesion.  On 26 January 2007, the back muscles were tender, but the examination otherwise unremarkable.  In physical therapy on 26 February 2007, 9 months prior to separation, flexion was 130 degrees and extension 50 degrees, both greater than VA normal values.  Her unsupported sitting posture was noted to be fair.  In primary care on 26 June 2007, the CI was observed to be able to recline and sit up without difficulty.  This implies normal or near normal function including motion.  The neurological examination and gait were normal.  Diffuse tenderness was present.  Repeat MRIs of the thoracic and lumbar spine on 25 July 2007 were essentially unchanged.  In neurosurgery on 2 August 2007, the neurological examination and gait were normal.  Tenderness was present, but the appearance of the spine was normal.  Balance was normal.  Repeat X-rays of the lumbar spine on 20 August 2007 were normal.  

The MEB NARSUM examination was accomplished on 6 September 2007, 3 months prior to separation, noted complaints of ongoing LBP which limited lifting to 10-15 pounds.  She could walk and cycle for exercise.  On examination, she was noted to have tenderness.  Flexion and extension were decreased, but not quantified.  Spasm was absent.  The neurological examination was normal and provocative testing for nerve root irritation negative.  It was noted that she could perform most of her duties, but could not lift, perform physical training, or fire a weapon (due to medications).  On 4 October 2007, 2 months prior to separation, the CI was evaluated after falling down 5 stairs.  Motion was painful at the extremes of motion for flexion and extension.  Her gait and stance remained normal.  

The VA Compensation and Pension (C&P) evaluation was not performed until 12 September 2013 over 5 years after separation and not probative for rating at separation.  Flexion was noted to be 80 degrees and the combined range of motion (ROM) was 220 degrees.  Both values were near normal and consistent with the records in evidence.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic back pain condition 10%, coded 5243 (intervertebral disc syndrome), citing constant pain.  The VA also rated the chronic back pain condition 10%, coded 5237, (lumbosacral strain), but based on the C&P examination 69 months after separation.  It cited combined ROM of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees and forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees.  There were no formal ROM accomplished for the MEB, but the measurements 9 months prior to separation did not support a compensable rating.  Several months later the CI was noted to be able to recline and sit up without difficulty implying normal or near normal motion.  Tenderness was documented though supporting a 10% rating; this does not provide an advantage to the CI.  No route to a higher rating was found.  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 LBP condition.  

Contended PEB Conditions: MDD, Pain disorder, and Migraines.  The panel’s main charge is to assess the fairness of the PEB’s determination that these conditions were not separately unfitting.  The formal PEB adjudicated these as Category II conditions which can be unfitting, but were not (at separation).  The panel observed that the minority voter for the PEB opined that both were unfitting at separation and recommended that the CI be placed on TDRL (temporary disability retired list).  The panel considered the evidence.  None were profiled or implicated in the commander’s statement.  None were considered by the MEB.  However, both the mental health and migraine conditions were noted to be unacceptable by the respective examiners for the NARSUM addenda.  The panel observed that the final performance report, which closed out on 19 September 2007, 3 months prior to separation, recorded that she met or exceeded duty requirements other than a failure to meet fitness (and weight) requirements.  There were no hospitalizations or emergency room visits for a mental health condition.  In the 21 months leading up to separation, the CI was placed on quarters for 24 hours on 4 occasions, 3 of which were after placement into the MEB process.  There was no performance-based evidence from the record that these 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 determinations for the MDD, pain disorder, and migraine conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the chronic 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 major depressive disorder, pain disorder, and migraine conditions, the panel unanimously recommends no change from the PEB determinations as not unfitting.  There are 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 20150811, 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

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2015-02231.

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.  The Board recommended no re-characterization or modification of your separation.

I 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.  I accept their recommendation that your application be denied.

Sincerely,

XXXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings