RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00308
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20051024

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Fuels Craftsman, medically separated for “chronic thoracic back pain” with a disability rating of 20%.  

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 - 20050712	VARD - 20060626	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Thoracic Back Pain	5243	20%	Chronic Thoracolumbar Strain	5237	20%	20060420	
Hypertension	Not Unfitting	Hypertension	7101	0%	20060420	
Overweight	Cat III	No VA Placement	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Chronic Thoracic Back Pain.  According to the service treatment record (STR) and the Review-In-Lieu-Of Medical Evaluation Board (RILO-MEB) narrative summary (NARSUM) and addendum, the CI’s thoracic back pain condition began in February 2000 with acute onset.  

The CI had steroid injections in February and March 2004 that failed.  In April Magnetic resonance imaging (MRI) revealed mild multilevel disc bulging with degenerative changes without cord compression.  Provocative diskography exactly reproduced the CI’s pain at T8-9, and T9-10 levels and he underwent intradiscal electro-annuloplasty (IDEA-minimally invasive surgery) of T8-T10 in July 2004.  After some initial relief, the CI’s pain returned to its pre-procedural level.  The 20 April 2005 Physical Therapy (PT) evaluation for MEB ROMs, 6 months prior to separation, stated “decreased active ROM.  (The CI) showed less than or equal to 25% of normal thoracic spine/lumbar spine active ROM (approximates flexion of 25 degrees).  Pain with all ranges/motions.”  

The 16 May 2005 Neurosurgical evaluation, 5 months prior to separation, noted complaints of a 5-year history of back pain localized to the right subscapular area extending to the mid-back.  The CI reported the pain at 8/10 at its worst and was taking chronic narcotic pain medication.  He stated pain was provoked by certain activities including strain of the area.  He reported no radiating pain, no numbness or weakness in the upper or lower extremities and no problems with his bowel or bladder.  He did report some occasional numbness in his mid-back area.  Physical examination showed normal (5/5) motor strength in both upper and lower extremities with sensation intact to light touch.  Gait was normal and the CI was able to heel and toe walk.  There was “normal range of motion (ROM) of the thoracic back although some limitation secondary to pain.”  Review of a recent MRI revealed mild thoracic scoliosis and disk osteophyte complex unchanged and mild at the levels of T3-4 and T7-8.  Surgery was not recommended.  

At the 20 April 2006 VA Compensation and Pension (C&P) evaluation, 6 months after separation, the CI reported daily lumbar and thoracic back pain that was constant and throbbing in nature and radiated down the right leg.  He reported no flares and no incapacitating episodes, and was not using any assistive devices.  The CI reported that he could no longer exercise, bowl or play with his children.  Physical examination showed a guarded gait with use of a cane for ambulation, with gait noted as normal under the spine exam section.  Thoracolumbar ROM showed flexion of 75 degrees with pain (90 normal), and combined ROM of 215 degrees (normal 240).  There was an increase in pain with repetition with an estimated additional limitation of motion of 10 degrees.  Straight leg raise elicited back pain on both sides.  There was significant paraspinal tenderness and paraspinal tension.  Lower extremity reflexes and motor strength were normal bilaterally and the CI was able to stand on his heels and toes.  Sensory testing was intact to light touch in the lower extremities.  The examiner’s impression was chronic thoracic spine strain (chronic pain syndrome), scoliosis with moderate to severe functional loss; and chronic lumbar spine strain with mild to moderate functional loss.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back pain condition 20%, coded 5243 (intervertebral disc syndrome), citing DoD and VASRD guidelines.  The VA also rated the back pain condition 20%, coded 5237 (lumbar spine strain), based on the C&P examination 6 months after separation, citing a “non-schedular” evaluation (normal VASRD 10% for limited ROM, with an additional 10% for functional loss due to pain).  

The panel deliberated the probative value of the examinations in evidence and adjudged that the neurosurgeon’s evaluation was closest to separation and aligned with the post-separation C&P examination findings and that pair of examinations had the highest probative value for rating at separation.  The panel agreed that the next higher 40% rating was not justified as no measured ROM examinations in evidence documented limitation of flexion approaching 30 degrees and there was no ankylosis of the thoracolumbar spine.  There was no documentation of intervertebral disc syndrome (IVDS) with incapacitating episodes (of at least 4 weeks) which would provide for a higher rating under that formula.  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 back pain condition.  

Contended PEB Condition:  Hypertension.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The contended condition was not profiled, implicated in the commander’s statement nor judged to fail retention standards.  There was no performance-based evidence from the record that the condition 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 the contended condition and so no additional disability rating is recommended.  

Contended PEB Condition:  Overweight.  The Board’s main charge is to assess the fairness of the PEB’s determination that the overweight condition was not separately unfitting and not compensable or ratable.  Overweight is a condition not constituting a physical disability, IAW DoDI 1332.38.  Therefore, the Board has no basis for recommending it as unfitting.  

BOARD FINDINGS:  In the matter of the chronic thoracic back pain condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the contended hypertension condition, the panel unanimously agrees that it cannot recommend it for additional disability rating.  In the matter of the contended overweight condition, the panel unanimously agrees that it cannot recommend it for additional disability rating.  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 20160519, 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-2016-00308.

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,

Attachment:
Record of Proceedings