RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01375
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20090928

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Aircraft Armament Systems Craftsman, medically separated for “chronic neck pain” and “chronic low back pain,” rated 10% each, with a combined 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 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 - 20090629	VARD - 20091117	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Neck Pain	5242	10%	DDD Cervical Spine	5242	10%	20090818	
Chronic Low Back Pain	5242	10%	Lumbar Spine Strain	5237	10%	20090818	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Chronic Neck Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI suffered an atraumatic onset of neck pain in 2007.  Imaging (MRI) demonstrated degenerative disc disease (DDD) at C3-4 without neural compromise.  There were no radicular symptoms, surgery was not recommended, and treatment entries showed normal neurological findings.  There was STR documentation of non-specific range of motion (ROM) limitation with painful motion but no evidence of abnormal spinal contour or incapacitating episodes.

The 9 April 2009 MEB NARSUM examination, 5 months prior to separation, documented daily neck pain rate at 2-3/10 and back pain that worsened as the day progressed to about 8/10 and was aggravated with prolonged standing or sitting.  The CI denied upper extremity radicular symptoms.  The physical examination recorded tenderness without note of spasm or abnormal spinal contour, “decreased extension due to pain, normal flexion/lateral movement,” and normal neurological findings (5/5 strength, intact sensation, symmetric reflexes).  ROM measurements were taken by physical therapy (PT) two weeks later (22 April) and showed, after repetition, flexion of 40 degrees (normal 45) and combined cervical ROM of 225 degrees (normal 340).  Painful motion was not addressed, but tenderness was present.

At the 18 August 2009 VA Compensation and Pension (C&P) evaluation, 1 month before separation, the CI reported non-specific “daily neck pain with stiffness” without radiation or neurological complaints.  The only listed functional limitations were exercising and sports, and the examiner specified that there had been no incapacitating episodes.  The physical examination recorded some spasm, but normal spinal contour.  There was no tenderness and neurological findings were normal.  Measured ROM was normal in all planes, with pain at extremes but no degradation with repetition.   

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the neck condition 10%, coded 5242 (degenerative arthritis of the spine), citing DoD guidance for applying VASRD guidelines.  The VA’s 10% rating under the same code cited §4.71a criteria applicable to the C&P ROM measurements.  There was no ROM evidence supporting a rating higher than 10%.  Although there was evidence of spasm, there no evidence of abnormal spinal contour or gait to support a 20% rating.  There was no documentation of incapacitating episodes that 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 of the cervical spine condition.

Chronic Low Back Pain.  The CI suffered an atraumatic onset of back pain in 2004, but disclosed a history of right lower back pain since age 16.  Imaging (MRI) demonstrated minor degenerative changes at L4/5 and surgery was not recommended.  Outpatient entries showed a normal gait and neurological findings.  There was STR documentation of non-specific ROM limitation with painful motion but no record of abnormal spinal contour or incapacitating episodes.

The 9 April 2009 MEB NARSUM examination, 5 months prior to separation, documented intermittent right lower extremity numbness without noting subjective weakness.  The physical examination recorded normal gait and neurological findings.  There was no tenderness or abnormal spinal contour and spasm was not addressed.  The 22 April 2009 PT ROM study after repetition showed flexion of 85 degrees (normal 90) and combined thoracolumbar ROM of 190 degrees (normal 240).  Painful motion was not addressed.  Motor strength of the bilateral lower extremities was 4+/5.

The 18 August 2009 VA C&P evaluation documented non-specific low back pain without radiation or neurological complaints, but monthly flares that rendered the CI “only able to do sedentary tasks.”  The examiner specified that there had been no incapacitating episodes.  The physical examination showed normal motor strength, sensations and reflexes.  Although there was some spasm, there was no tenderness or abnormal spinal contour or gait.  ROM testing showed flexion of 70 degrees and combined ROM of 220 degrees, with pain at extremes but no degradation with repetition.   

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10% under code 5242 and referenced DoD and VASRD guidance.  The VA’s 10% rating under code 5237 (thoracolumbar strain) cited painful and limited motion.  There was no ROM evidence supporting a rating higher than 10%.  There was no evidence of abnormal gait or spinal contour to support a 20% rating even though there was evidence of spasm.  There was no significant evidence for ratable peripheral nerve impairment that would provide for additional rating (only the PT examination showed evidence of motor weakness).  There were no incapacitating episodes that would provide for a higher rating under that formula.  After due deliberation, considering all evidence and with deference to reasonable doubt, the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication of the thoracolumbar condition.

BOARD FINDINGS:  In the matter of the cervical spine condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the thoracolumbar condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  There are no other conditions within the panel’s scope of review for consideration.  Therefore, the panel recommends 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 20170221, 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-2017-01375.

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