RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE: pd-2017-01138
BRANCH OF SERVICE:  AIR FORCE	SEPARATION DATE:  20060213

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Security Forces Journeyman, medically separated for “chronic neck pain” with a disability rating of 20%.

CI CONTENTION:  Current conditions support a higher rating.  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 - 20051228	VARD - 20061107	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Neck Pain	5243	20%	Degenerative Disc Disease (DDD), Cervical Spine	5237	10%	20060925	
Chronic Back Pain, Myofascial	Category II	DDD, Lumbosacral Spine	5237	20%	20060925	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:

Neck Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s neck condition began in April 2005 after a motor vehicle accident (MVA) and was aggravated by a second MVA in August 2005.  Diagnostic imaging (MRI) showed C5-C6 spinal straightening and degenerative changes.  There was no surgical indication.  The 10 November 2005 MEB NARSUM, 3 months prior to separation, noted complaints of chronic neck and back pain.  The CI reported the neck pain radiated into the trapezius muscles bilaterally and her arms went numb while recumbent.  She reported weakness, particularly of the forearms, but denied dropping things.  The physical examination cited the findings of the 4 November 2005 neurosurgical evaluation, which included tenderness of the lower cervical spine.  Neck range of motion (ROM) was noted as “decreased” flexion and extension and “slightly decreased” rotation to the left.  The physical therapy (PT) ROM study showed flexion of 20 degrees (normal 45) and combined ROM of 205 degrees (normal 340).  Painful motion was not addressed.  Upper extremity strength and sensation were normal.  Upper extremity reflexes were decreased, but symmetrical bilaterally.  

At the 25 September 2006 VA Compensation and Pension (C&P) examination, 7 months after separation, the CI reported chronic neck pain with intermittent weekly flare-ups.  Physical examination revealed a normal gait and posture.  There was no motor or sensory loss.  Cervical flexion was 35 degrees and combined ROM was 210 degrees; painful motion was present.  Repetitive ROM reduced flexion to 25 degrees.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the neck condition 20%, coded 5243 (intervertebral disc syndrome).  The VA rated the neck condition 10%, coded 5237 (cervical strain), based on the C&P examination, citing limitation of flexion.  

The panel agreed that a 20% rating, but no higher, was justified for limitation of flexion greater than 15 degrees but not greater than 30 degrees, as reported on the MEB NARSUM examination most proximate to separation and at the VA examination.  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 neck condition.

Contended PEB Condition:  Chronic Back Pain.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended Category II back condition was not unfitting.  Although neither the 14 November 2005 commander’s statement nor the 27 December 2005 L4 profile implicated a specific medical condition, both documents listed the following restrictions: no running, no push-ups, no sit-ups, and no web gear (20 pounds weight restriction for lifting or helmet).  Throughout the course of treatment the CI consistently reported neck pain and back pain, and at times she reported that low back pain was her main problem.  The MEB judged the “chronic neck and back pain” did not meet retention standards.  The evidence revealed both the back and neck conditions were treated concurrently status post MVA, but considered separate and distinct diagnoses with severable symptoms as documented by the MEB NARSUM.  The MEB NARSUM noted chronic back and neck pain with abnormal findings of the neck and back documented.  Lumbar MRI in August 2005 showed DDD, and lumbar discography performed 6 September 2005 was positive at L4-L5 and L5-S1 and reproduced the CI’s back pain.  Based on the preponderance of evidence, the panel agreed the back condition, as an isolated condition, would have rendered the CI incapable of performing her military duties; and, recommends the back condition as a separately unfitting condition.  The panel then considered its rating recommendation at the time of separation.  According to the STR and MEB NARSUM, the CI’s back condition also began during the previously mentioned MVA.  Diagnostic imaging showed abnormalities as noted above. 

The 10 November 2005 MEB NARSUM examination, 3 months prior to separation, noted complaints of chronic back pain that bothered her more than her neck pain.  The CI denied any neurological symptoms, but noted she limped at times due to pain.  The physical examination cited the findings of the 4 November 2005 neurosurgical evaluation.  The CI had an abnormal gait favoring the right leg.  There was thoracic and lumbar spine tenderness.  The PT ROM study showed flexion of 55 degrees (normal 90) and combined ROM of 95 (normal 240).  Painful motion was not addressed.  Lower extremity strength was normal.  Sensation was decreased in the L4 distribution of the left leg and increased in the L5 distribution on the right.  Reflexes were symmetrical bilaterally. 

At the 25 September 2006 VA C&P examination, 7 months after separation, the CI reported chronic back pain that radiated to the mid-back with intermittent weekly flare-ups.  Physical examination revealed a normal gait and posture.  There was no motor or sensory loss.  Lumbar flexion was 55 degrees and combined ROM was 155 degrees; painful motion was present.  Repetitive ROM reduced flexion to 40 degrees.  Straight leg raise testing to elicit radicular symptoms was positive bilaterally.  

The panel directed attention to its rating recommendation based on the above evidence.  The panel agreed that a 20% rating, but no higher, was justified for limitation of flexion greater than 30 degrees but not greater than 60 degrees, as reported on the MEB NARSUM and VA examinations.  There was no documentation of intervertebral disc syndrome with incapacitating episodes which would provide for a higher rating under that formula.  After due deliberation, the panel agreed that the preponderance of the evidence with regard to the functional impairment of the back condition favors its recommendation as an additionally unfitting condition for disability rating.  It is appropriately coded 5237 and meets the VASRD §4.71a criteria for a 20% rating.

BOARD FINDINGS:  In the matter of the chronic neck condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended chronic back condition, the panel agrees that it was unfitting and recommends a disability rating of 20%, coded 5237 IAW VASRD §4.71a.  There are no other conditions within the panel’s scope of review for consideration.  

The panel recommends the CI’s prior determination be modified as follows; and, that the discharge with severance pay be re-characterized to reflect permanent disability retirement, effective the date of medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Neck Pain	5243	20%	
Chronic Back Pain	5237	20%	
COMBINED	40%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170224 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 Applicant:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-01138.

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 not appropriate under the guidelines of the Veterans Affairs Schedule for Rating Disabilities.  Accordingly, the Board recommended your separation be re-characterized to reflect disability retirement, rather than separation with severance pay.

I have carefully reviewed the evidence of record and the recommendation of the Board.    I concur with that finding, accept their recommendation and determined that your records should be corrected accordingly.  The office responsible for making the correction will inform you when your records have been changed.

As a result of the aforementioned correction, you are entitled by law to elect coverage under the Survivor Benefit Plan (SBP).  Upon receipt of this letter, you must contact the Air Force Personnel Center at XXXXXXXXXXXXXXXXXX to make arrangements to obtain an SBP briefing prior to rendering an election.  If a valid election is not received within 30 days from the date of this letter, you will not be enrolled in the SBP program unless at the time of your separation, you were married or had an eligible dependent child, in such a case, failure to render an election will result in automatic enrollment.

						Sincerely,

								XXXXXXXXXXXXXXXXXX
								Director
								Air Force Review Boards Agency

Attachment:
Record of Proceedings