RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00686
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20050912

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Materiel Management Journeyman, medically separated for “chronic low back pain” with a disability rating of 10%.  

CI CONTENTION:  “Chronic low back pain, hypertension, migraine headaches.”  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 Medical Evaluation Board (MEB), but determined by the PEB 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.  The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence relevant to application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards for 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, which operates 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 disability at the time of separation.   

RATING COMPARISON:  

SERVICE PEB - 20050429	VARD - 20060421	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5237	10%	Low Back Strain	5237	10%	20060306	
Hypertension	Cat II	Hypertension	7101	0%		
Migraine Headaches		Migraine Headaches	8100	0%		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s back condition began in August 2003 of unknown etiology, but was aggravated in June 2004 after he was dropped while lying on a stretcher during an exercise.  Diagnostic imaging (X-rays and MRI) was normal.  The 27 January 2005 MEB NARSUM examination, 8 months prior to separation, showed tenderness with an otherwise normal back examination.  The 28 February 2005 primary care clinic visit for MEB range of motion (ROM) measurements, 7 months prior to separation, recorded back flexion of 15 degrees (normal 90) and combined ROM of 50 degrees (normal 240).  

At the 6 March 2006 VA Compensation and Pension (C&P) examination, 6 months after separation, the CI reported 7/10 back pain with flares to 8/10.  Physical examination showed normal gait and posture without obvious spinal deformity.  There was tenderness but no muscle spasm.  ROM was painful with flexion of 70 degrees and combined ROM of 190 degrees.  There was no additional limitation or joint fatigability with repetitive motion testing.  X-rays showed slight dextroscoliosis of the thoracolumbar junction but were otherwise normal.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, coded 5237 (lumbosacral strain), citing painful motion.  On appeal, the Secretary of the Air Force Personnel Council upheld the 10% rating.  The VA rated the back condition 10%, coded 5237, based on the C&P examination, citing limitation of forward flexion to 70 degrees.  

The only pre-separation measured ROMs were the 28 February 2005 primary care clinic back measurements which did not mention pain, tenderness, repetition, or other critical components of a ratable thoracolumbar spine examination IAW VASRD §4.46 (accurate measurement).  The primary care clinic evaluation did not align with the CI’s underlying pathology or the remainder of the STR evidence, which predominantly described slightly limited painful back motion with tenderness.  The VA examination, performed closer to the date of separation, was more detailed and compliant with VASRD rating guidelines, and best aligned with the entirety of the record.  Therefore, the panel placed greater probative value on the VA examination.  

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) and/or combined ROM (greater than 120 degrees but not greater than 235 degrees), as reported on the VA examination proximate to separation.  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 documentation of intervertebral disc syndrome with incapacitating episodes, 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 there was insufficient cause to recommend a change in the PEB adjudication for the back condition.  

Contended PEB Conditions:  Hypertension and Migraine Headaches.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  Neither of the conditions were profiled, implicated in the commander’s statement, nor judged to fail retention standards.  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 there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions, so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the back condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended hypertension and migraine headaches, the panel recommends no change from the PEB determinations as not unfitting.  There are no other conditions within the panel’s scope of review for consideration.  Therefore, the panel recommends 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 20170217, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs 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-2017-00686.

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