RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01342
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20060403 

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Personnel Craftsman, medically separated for “upper back pain” with a disability rating of 10%.  

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 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 - 20060130	VARD - 20061019	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Upper Back Pain	5235-5243	10%	Traumatic Compression Fracture T5, T6, and T7…	5242-5235	10%	20060804	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Upper Back Pain.  According to the service treatment record (STR) and the MEB narrative summary (NARSUM), the CI’s back condition began in December 1996 when she injured herself skiing, and sustained a thoracic fracture to T5-T7.  Magnetic resonance imaging studies of the thoracic spine in June 2005) showed anterior compression of the spine at T5, T6 and T7 with a small right paracentral disk herniation at T8-T9.  Computed tomography of the thoracic spine June 2005 showed mild anterior wedge compression fractures as described above with 10-20% anterior loss at T6.  Degenerative disk changes were present predominantly in the lower thoracic spine below T7.  Evaluation by neurosurgery concluded with a diagnosis of degenerative changes secondary to the past compression fractures, and recommended non-surgical treatment.  Medications included lidocaine transdermal (pain), meloxicam and baclofen for spasms and amitriptyline for pain.  

At the time of the MEB physical therapy appointment on 14 September 2005 (7 months prior to separation) the CI reported pain described as burning bilaterally and having "knots” and spasm.  She was on an 8 hour per day work profile.  On examination thoracolumbar spine pain was elicited by motion, and range of motion (ROM) was within normal limits.  The thoracolumbar spine had a normal appearance, and there was no tenderness or muscle spasm but posture was abnormal.  Gait was normal.  The 30 December 2005 MEB NARSUM examination, 4 months prior to separation, noted complaints of daily pain, worse with bending and twisting movements.  Physical examination showed pain in the thoracic spine with movement which resolved within five seconds of cessation of movement.  There were no motor or sensory deficits observed.  

At the 4 August 2006 VA Compensation and Pension (C&P) evaluation, 4 months after separation, the CI reported upper back and lower back pain but no radiation to lower or upper extremities.  She reported ROM limited by 50% during flare-ups.  Sometimes she needed help for grooming and dressing.  The examiner found thoracolumbar ROM measurements of flexion at 90 degrees (normal 90) and combined ROM of 240 degrees (normal 240), and there was an additional limitation with repetitive motion of 6 degrees for each side in rotation.  There was objective evidence of painful motion, spasm and tenderness.  ROM was additionally limited 6 degrees in rotation bilaterally.  There was no fixed deformity.  Her gait was normal, but unsteady.  X-rays showed minimal scoliosis with mild degenerative formation.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, coded analogously as 5243 (intervertebral disc syndrome).  The VA also rated back condition 10%, coded analogously as 5235 (vertebral fracture or dislocation), based on the C&P examination, citing forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or, combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees.  

The panel agreed a 10% rating was justified for the presence of painful motion at the NARSUM examination.  The panel also agreed that a 10% rating, but no higher, was justified for limitation of flexion (greater than 60 degrees but not greater than 85 degrees), as reported on the VA examinations proximate to separation.  The panel discussed the spasm and worsened gait at the VA C&P examination after separation, however the panel placed greater probative value on the NARSUM examination since it was before separation.  Although there was muscle spasm, it was not 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 (IVDS) 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 that there was insufficient cause to recommend a change in the PEB adjudication for the upper back pain condition.  

BOARD FINDINGS:  In the matter of the upper back pain condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  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 20170206, 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

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-01342.

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