RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-01240
BRANCH OF SERVICE:  air force	SEPARATION DATE:  20060227

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a Reserve O3, Clinical Nurse, medically separated for “chronic back pain” with a disability rating of 0%.

CI CONTENTION:  Current back condition supports 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 - 20070820	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Back Pain	5237	0%	No VA Examination Proximate to Separation in Evidence	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:

Chronic Back Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s back condition began approximately in 2002 after lifting a heavy patient.  An X-ray of the lumbar spine on 9 December 2002 showed a normal lumbar spine.  The record then falls silent until February 2004 when the CI began treatment in the chiropractic clinic.  An MRI on 6 May 2004 was normal.  She continued treatment with medications, duty restrictions, and physical therapy, but was not able to meet full duty requirements or deploy.  After she had been on a profile for 1 year, she was entered into the MEB process.  

The 27 October 2005 MEB NARSUM examination, 4 months prior to separation, noted complaints of daily back pain which worsened with prolonged activity and sitting.  The CI denied any numbness, tingling, or weakness.  She reported that her exercise was limited to bicycling.  She could not do sit-ups due to her back pain.  The physical examination showed a normal gait and posture.  There was no spinal tenderness of the thoracolumbar spine.  Spinal range of motion (ROM) was greater than 90 degrees (normal 90) with no other ROMs recorded; painful motion and muscle spasm were not addressed.  The neurological examination and gait were normal.  

In pain management on 22 December 2005, the CI noted her back pain limited walking to 3-4 blocks.  She also reported her hobbies included snowboarding and mountain biking.  The panel could not reconcile these inconsistencies.  The ROM was full but painful.  Tenderness was present, but the location was not specified.  The neurological examination and gait were normal.  In pain management on 16 January 2006, 1 month prior to separation, the CI reported ongoing back pain.  The gait and neurological examination were normal.  There was tenderness of the lumbosacral spine.  The ROM was painful but full.  On 24 January 2006 in physical therapy, the CI reported ongoing back pain with improvement on her new medications.  She worked out on a Bowflex machine and enjoyed snowboarding.  She was noted to have full motion.  Strength and reflexes were normal and provocative testing for nerve root irritation was negative.  The CI was seen again in physical therapy on 14 February 2006.  She was again noted to have full but painful ROM.  Strength and reflexes remained intact.  A pain management encounter 7 days before separation revealed a normal spinal contour.  Tenderness was present.  The ROM was within normal limits; painful motion was not addressed.  The gait and neurological examination were normal.  One month after separation, in pain management, the ROM and neurological examination were normal and tenderness was absent.  Subsequent examinations did record tenderness.  There was no VA examination in evidence proximate to separation.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 0%, coded 5237 (lumbosacral strain).  There was insufficient limitation of motion proximate to separation to support a 10% rating.  Painful motion was recorded by family practice, physical therapy, and civilian medical center examinations proximate to separation, but does not support a compensable rating in the absence of objective pathology.  Both the X-ray and MRI were normal.  Tenderness was typically recorded by the pain management physician.  This supported a 10% rating.  There was no muscle spasm or guarding severe enough to result in an abnormal gait or spinal contour.  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 recommends a disability rating of 10% for the back condition, coded 5237.

BOARD FINDINGS:  In the matter of the back condition, the panel recommends a disability rating of 10%, 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, effective the date of medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Back Pain	5237	10%	

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD  20762

XXXXXXXXXX
XXXXXXXXXX
XXXXXXXXXX

Dear XXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-01240.

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 modification of your assigned disability rating without re-characterization of your 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 direct that your records be corrected as set forth in the attached copy of a Memorandum for the Chief of Staff, United States Air Force.  This will not result in any change to your separation documents or the amount of severance pay you are entitled to.  Disability severance pay is computed the same regardless of a rating of 0, 10 or 20 percent.