RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02798
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20060808

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Personnel Specialist, medically separated for “chronic low back syndrome” and “chronic cervical pain,” rated 10% each, with a combined disability rating of 20%.  

CI CONTENTION:  “The issue makes maintaining a job difficult.  Migraines can keep me down for days.”  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 - 20060616	VARD - 20070216	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Syndrome	5237	10%	Lumbar Strain	5237	10%	20060918	
Chronic Cervical Pain	5243	10%	Degenerative Disc Disease Cervical Spine 	5243	20%	20060918	
Migraine Headaches	Not Unfitting 	Migraine Headaches	8100	10%	20060918	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Chronic Low Back Syndrome and Chronic Cervical Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s chronic low back syndrome and chronic cervical pain began in 2005 without known injury or trauma.  Despite numerous primary care, chiropractor, and orthopedic visits along with manipulation, prescription medication, and rehabilitation exercises, the CI reported no improvement.  

At the 22 February 2006 MEB NARSUM examination, 6 months prior to separation, the CI reported persistent neck and low back pain with prolonged sitting or standing, and intermittent numbness in the fingers bilaterally in a non-dermal distribution.  Physical examination showed neck tenderness with some discomfort noted with flexion, extension, and lateral bending to the right.  Pain was noted along the left trapezius with lateral bending and rotation to the right, but no limitation in motion was noted.  Tenderness was also noted along the lumbar spine.  Back range of motion (ROM) in all planes of movement was normal.  The subsequent 2 May 2006 MEB NARSUM examination, 3 months prior to separation, showed no changes.

Chronic Low Back Syndrome.  At the 18 September 2006 VA Compensation and Pension (C&P) examination, 1 month after separation, back pain was reported in the upper lumbar area described as a constant ache with occasional radiation to the back of the left thigh.  No muscle spasms were reported.  Flare-ups occurred three times per month but no incapacitation was reported.  Physical examination showed steady gait and no significant tenderness or muscle spasm.  Lumbar spine forward flexion was 90 degrees (normal) and combined ROM was 240 degrees (normal).  The examiner noted subjective complaints of pain with motion.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, coded 5237 (lumbosacral strain).  The VA also rated the back condition 10%, coded 5237, based on the C&P examination.  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 NARSUM examinations noted the presence of painful motion and localized tenderness justifying a 10% rating.  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 intervertebral disc syndrome (IVDS) with incapacitating episodes which would provide for a higher rating under that formula.  While the CI may have experienced radiating pain from the back condition, this is subsumed under the general spine rating criteria, which specifically states “with or without symptoms such as pain (whether or not it radiates).”  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 back condition.  

Chronic Cervical Pain.  At the VA C&P examination, 1 month after separation, the CI reported pain to the lower and mid cervical area on the left side of the neck.  No muscle spasms were reported.  Flare-ups were reported once a week with no triggers and no incapacitating episodes.  Physical examination showed no significant tenderness or muscle spasms.  Cervical flexion was 35 degrees (normal 45) and combined ROM was 150 degrees (normal 340) without complaints of pain.  No limitation of motion with repetition was noted.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the neck condition 10%, coded 5243 (IVDS).  The VA rated the neck condition 20%, coded 5243, based on the C&P examination.  In assigning probative value to these somewhat conflicting examinations, members noted the post-separation VA examination was significantly different from the two MEB NARSUMs and other STR evidence and as such, placed less probative rating value on that examination.  The panel agreed there was no limitation of forward flexion or combined ROM of the cervical spine to support a 10% rating under the General Rating Formula for Diseases and Injuries of the Spine.  However, there was evidence of painful motion to support a 10% rating.  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.  While the CI may have experienced radiating pain from the neck condition, this is subsumed under the general spine rating criteria, which specifically states “with or without symptoms such as pain (whether or not it radiates).”  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:  Migraine Headaches.  The panel’s main charge is to assess the fairness of the PEB determination that the contended condition was not unfitting.  The contended condition was not listed on the current profile and no profiles for migraines were in the records available for review; however, the commander’s statement noted that at times, the CI had been placed on a profile and she had difficulty concentrating due to numerous onsets of painful headaches and neck aches.  In the two years prior to separation, records show the CI only missed 5 days of work for migraines.  Her work was reported as adequate and her performance report shows she excelled.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition, so no additional disability rating is recommended.  

BOARD FINDINGS: In the matter of the back condition and IAW VASRD §4.71, the panel recommends no change in the PEB adjudication.  In the matter of the neck condition, and IAW VASRD §4.71, the panel recommends no change in the PEB adjudication.  In the matter of the contended migraine headaches, the panel agrees it cannot recommend it for additional disability rating.  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 20170417, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-02798.

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