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-2017-02300.

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,

								XXXXXXXXXX

Attachment:
Record of Proceedings 

RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-02300
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20060206

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6, Aerospace Medical Service Craftsman, medically separated for “upper back pain related to motor vehicle accident and disc degeneration” 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 FPEB - 20051221	VARD - 20070126	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Upper Back Pain…	5243	10%	Thoracolumbar Spine with Spondylosis and Degenerative Disc Disease	5243	10%	20061220	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10% 	

ANALYSIS SUMMARY:  

Upper Back Pain. According to the service treatment record and MEB narrative summary (NARSUM), the CI’s back condition began in January 2001 following a motor vehicle accident.  The pain improved, but was aggravated in June 2002, and she underwent chiropractic manipulations, physical therapy, epidural injections, and orthopedic evaluation without significant improvement.  In 2004, a thoracic spine MRI showed a small posterior right-sided disc protrusion at T8-9 with mild thecal sac effacement, and a lumbar spine MRI showed disc degeneration with a prominent bulge at L5 to S1, but no spinal stenosis or neural impingement at any level.  A cervical spine MRI was normal, and surgery was not recommended.  
The 9 June 2005 MEB NARSUM examination, 8 months prior to separation, noted CI complaints of moderate upper back pain which was significantly increased with bending, stooping, lifting or and staying in a stationary position for prolonged periods.  Physical examination showed full thoracolumbar range of motion (ROM) during flexion, extension and rotation.  The CI reported tightness in the upper and mid portion of the spine corresponding to areas of interest on an MRI, and palpation in these areas elicited minor discomfort.  Neurological examination showed normal strength, sensation and reflexes throughout.  A MEB addendum dated 26 October 2005, 3 months before separation, noted no changes in symptoms and continued intermittent back pain.  

At the 20 December 2006 VA Compensation and Pension (C&P) examination, 10 months after separation, the CI reported no thoracic spine symptoms except during flare-ups, which occurred twice a month and lasted 2 days, and were associated with intermittent muscle spasms without known precipitating factors.  Physical examination showed slight thoracic paravertebral tenderness bilaterally, but the spine was non-tender with no abnormal curvatures noted.  Thoracolumbar ROM measurements showed flexion of 90 degrees (normal) and combined ROM of 240 degrees (normal) and no additional functional impairment due to pain, fatigue, weakness or lack of endurance following repetitive motion.  The CI had no incapacitating episodes in the previous 12 months of either the cervical or thoracic spine, and there was no swelling, effusion, tenderness or muscle spasm; gait, stance and coordination were normal.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, coded 5243 (intervertebral disc syndrome (IVDS)).  The VA also rated the back condition 10%, coded 5243, based on the C&P examination, citing chronic and severe symptoms of back pain.  Members agreed that there was no limitation of thoracolumbar spine motion to support a 10% rating under the General Rating Formula for Diseases and Injuries of the Spine, however the MEB NARSUM and VA examinations noted the presence of localized tenderness and a 10% rating was therefore warranted.  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 IVDS with incapacitating episodes which would provide for a higher rating under that formula.  After due deliberation, considering all 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.  

BOARD FINDINGS:  In the matter of the back 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 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 20170219, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record