RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03814
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20080929

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Personnel Craftsman, medically separated for “chronic low back pain” and “neck pain,” rated 10% each, with a combined disability rating of 20%.  

CI CONTENTION:  The CI submitted an extensive statement requesting all conditions be reviewed.  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 - 20080717	VARD – 20090422*	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5237	10%	Developmental Lumbarization with Subsequent Spondylolysis of L5	5237	NSC	20090224	
Neck Pain	5237	10%	Developmental Mild Cervical Kyphosis	5237	NSC	20090224	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  NA	
* Veterans Court of Appeals directed VARD dated 20150611 to rate Lumbar Strain 10% and Cervical Strain 10%, decision effective 20080930.

ANALYSIS SUMMARY:  

Chronic Low Back Pain (LBP).  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s LBP condition began in December 2004 after she was involved in a motor vehicle accident.  Over a four year period she received physical therapy, non-steroidal anti-inflammatory drugs (NSAIDs), and treatment/ evaluation by a chiropractor and a pain specialist.  Initial lumbar x-rays done in January 2005 were normal.  An MRI done in February 2007 revealed that she had minimal disc bulging at L1-L2 and L4-L5 which was without any focal component, nerve root impingement, or displacement.  There was no surgical indication.  

The 17 March 2008 MEB NARSUM examination, 6 months prior to separation, noted complaints of daily constant LBP rated at an intensity of 3-4/10 that would increase to 7-8/10 with heavy lifting greater than 25 pounds, running, bending, prolonged walking/sitting/standing, bicycling, performing household chores, and wearing of protective combat gear.  She also reported these activities sometimes resulted in intermittent muscle spasm.  She denied any radiculopathy, incontinence, or paresthesias, and reported that her pain was severe and extreme at the end of her duty day.  She did not report any sleep disturbance.  At the physical examination the CI was in no apparent distress.  There no tenderness to the lumbar paraspinal region.  Her thoracolumbar range of motion (ROM) was 50 degrees forward flexion with pain (90 normal) and “decreased lateralization secondary to pain.”  Her muscle strength was 5/5 in her upper and lower extremities bilaterally.  There was normal distal sensation to light touch, vibration, and proprioception.  Deep tendon reflexes (DTR’s) were 2+ throughout. 

At the 24 February 2009 VA Compensation and Pension (C&P) examination, 5 months after separation, the CI reported continued daily pain in the middle of her lower back that she estimated was at 2-3/10 on the pain scale.  She reported flare-ups 1-2 times per week, sometimes more frequently, with a pain level of 5-6/10.  Flare-ups were caused by prolonged sitting, standing, yard work, or lifting heavy objects.  She also reported occasional shooting pain down her left leg toward her left knee, occurring 1-2 times per month, with pain estimated at 5-6/10.  Physical examination showed thoracolumbar ROM was 90 degrees forward flexion (normal) and combined ROM 240 degrees (normal).  There was no painful motion, tenderness, edema, spasms, fatigability, weakness, or instability noted.  There was no additional limitation of motion with repetition due to pain, weakness, fatigue, or lack of endurance.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the LBP condition 10%, coded 5237 (lumbar spine strain), citing the VASRD and 2008 National Defense Authorization Act (NDAA) standards.  The VA rated the LBP condition as not service connected, coded 5237 (lumbar spine strain), based on the C&P examination, citing the condition was considered a congenital or developmental defect and not subject to service connection.  The panel examined the range of motions for the lumbar spine and found them consistent with a 10% rating of the disability as measured by the VA 5 months after separation.  The NARSUM examination was insufficient for rating the ROM.  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 LBP condition.

Neck Pain. According to the STR and MEB NARSUM, the CI’s neck pain condition began in December 2004 after a motor vehicle accident.  In January 2005 cervical x-rays were normal.  A March 2008 cervical spine MRI was also normal.  There was no surgical indication.  The 17 March 2008 MEB NARSUM examination, 6 months prior to separation, noted complaints of daily constant cervical pain rated at an intensity of 3-4/10 that would increase to 7-8/10 with heavy lifting greater than 25 lbs., running, bending, prolonged walking/sitting/standing, bicycling, performing household chores, and wearing of protective combat gear.  She denied any radiculopathy, incontinence, or paresthesias, and reported that her pain was severe and extreme at the end of her duty day.  She did not report any sleep disturbance.  Physical examination showed muscle strength was 5/5 in her upper and lower extremities bilaterally.  There was normal distal sensation to light touch, vibration, and proprioception.  DDTRs were 2+ throughout.  There were no specific cervical ROM measurements in the NARSUM examination, however the examiner noted that “all other joints have FROM (full ROM) without any tenderness”.  

At the 24 February 2009 C&P examination, 5 months after separation, the CI reported episodic dull pain in her neck that she characterized as 3/10 in intensity.  She reported her activities dictated whether or not she would experience the neck pain, e.g. working at her computer all day would cause the pain.  She reported that this was occurring several times per week. There was no radiation and no flare-ups were reported.  She stated that physical therapy and chiropractic manipulation alleviated her pain in the short term, but that the pain would come back.  Physical examination showed cervical spine ROM at 45 degrees flexion (normal) and combined ROM at 335 degrees (normal 340).  There was no tenderness along the cervical spine.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the neck pain condition 10%, coded 5237 (cervical spine strain), citing application of the VASRD and 2008 NDAA guidance.  The VA rated the neck pain condition as not service connected, coded 5237 (cervical spine strain), based on the C&P examination, citing that the condition was considered a congenital or developmental defect which is unrelated to military service and not subject to service compensation.  The panel examined the range of motions for the cervical spine and found them consistent with a 10% rating of the disability as measured by the VA five months after separation.  The NARSUM examination was insufficient for rating the ROM.  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 neck pain condition.  

BOARD FINDINGS:  In the matter of the chronic back pain condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the neck pain 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 20170505, 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-2017-03814.

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