RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03366
BRANCH OF SERVICE:  air force	SEPARATION DATE:  20060321

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Aerospace Maintenance Journeyman, medically separated for “mid thoracic back pain” with a disability rating of 10%.

CI CONTENTION:  The CI made no specific contention.  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 - 20050928	VARD - 20061023	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Mid Thoracic Back Pain	5237	10%	Thoracolumbar Degenerative Joint Disease	5242	10%	20060719	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:

Mid Thoracic Back Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s back condition began in August 2003 without a specific injury.  Radiographic studies showed a normal thoracic spine.

The 8 July 2005 MEB NARSUM examination, 9 months prior to separation, noted complaints of back pain aggravated by lifting or carrying items to one side, running, twisting and static postures.  Physical examination showed a normal gait and no posture abnormalities.  There was spinal tenderness, but motor strength was normal.  Mid-thoracic spine range of motion (ROM) was “significantly limited” during left and right rotation; painful motion was elicited.  Two subsequent MEB NARSUM Addendums, dated 28 August 2005 and 11 October 2005, showed no change to the initial MEB NARSUM’s examination.  A 14 December 2005 CT scan was normal.  Serial chiropractic examinations from August 2005 to January 2006 consistently showed normal spinal posture with spinal tenderness and muscle spasm.  During the Pain Clinic evaluation, 1 week prior to separation, the CI complained of back pain.  Physical examination showed spinal tenderness.

At the 19 July 2006 VA Compensation and Pension (C&P) examination, 4 months after separation, the CI reported mid back pain, muscle spasms, stiffness, weakness and had a sense of electricity going down his arms.  He also reported that his back pain became so severe that it caused him to blackout 2-3 times per month.  Physical examination showed a normal gait and spinal contour.  The CI was able to heel and toe walk.  There was spinal tenderness and muscle spasm.  Motor strength and sensation testing were normal except for elbow and knee reflexes which were slightly hyperactive.  ROM was flexion to 70 degrees (normal 90) and combined ROM was 200 degrees (normal 240); painful motion and right arm tingling with mild crepitus were elicited.  There was no change in ROM with repetition.  An MRI was normal, but a bone scan showed degenerative uptake in the sacroiliac joint, lower thoracic spine and lower lumbar spine.

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 5242, (degenerative arthritis of the spine), based on the C&P examination 4 months after separation, citing limitation of flexion and painful motion.  The panel agreed that a 10% rating, but no higher, was justified for limitation of flexion greater than 60 degrees but not greater than 85 degrees based on the VA evaluation most proximate to separation.  Spinal tenderness was recorded throughout the STR and on the VA examination.  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 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 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 20170402, 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-2017-03366.

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