RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-04437
BRANCH OF SERVICE:  AIR fORCE	SEPARATION DATE:  20060710

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Aviation Resource Management Craftsman, medically separated for “neck and upper back pain” 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 PEB -20060515	VARD - 20060929	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Neck and Upper Back Pain	5237	10%	S/P Whiplash Injury, Cervical Spine	5243	10%	20060801	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Chronic Neck and Upper Back Pain.  The PEB combined the neck and upper back pain conditions as a single unfitting condition coded analogously to 5237 (cervical strain) and rated 10%.  The approach by the PEB not uncommonly reflected its judgment that the constellation of conditions was unfitting, and there was no need for separate fitness adjudications.  The panel’s initial charge in this case was therefore directed at determining if the PEB’s approach of combining conditions under a single rating was justified in lieu of separate ratings.  When considering a separate rating for each condition, the panel considers each bundled condition to be reasonably justified as separately unfitting unless a preponderance of evidence indicates the condition would not cause the member to be referred into the DES or be found unfit because of physical disability.  When the panel recommends separate fitness recommendations in this circumstance, its recommendations may not produce a lower combined rating than that of the PEB.  The evidence for the neck and upper back condition is presented with attendant recommendations regarding separate unfitness and separate rating, if indicated.  

According to service treatment record and MEB narrative summary (NARSUM), the CI’s neck and upper back condition began in June 2004 following a motor vehicle accident.  In early 2005, the CI began a series of steroid injections that left her essentially pain free for nearly a year; however, her symptoms returned after attending M-16 refresher training in January 2006.  The CI was treated with medications as well as trigger point injections, all with little relief.  The February 2006 X-rays and myelogram of the cervical spine revealed no cervical deformities.

At the 30 March 2006 MEB NARSUM examination, 4 months prior to separation, the CI’s physical examination (PE) revealed bilateral tenderness about the paraspinal junction between the cervical and thoracic spine.  Additionally, cervical muscle spasms were noted.  Range of motion (ROM) of the cervical spine was normal except for extension which was described as “decreased.”  Painful motion was present.  No sensory abnormalities were noted and motor strength and reflexes of the upper extremities were normal.  

At the 1 August 2006 VA Compensation and Pension (C&P) evaluation, 1 month after separation, the CI reported intermittent neck and upper back pain with occasional pain in the region of the right shoulder blade.  Pain primarily occurred with working out or heavy lifting, however the CI reported she could safely lift 20-30 pounds.  The CI could walk without limits, however experienced pain with prolonged sitting.  Her PE noted a normal gait and posture.  Cervical ROM showed normal flexion.  Extension was decreased at 30 degrees (normal 45), and bilateral rotation was decreased at 60 degrees to the right and 75 degrees to the left (normal 80). 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the neck and upper back condition 10%, coded 5237.  The VA rated the neck condition 10%, coded 5243 (intervertebral disc syndrome), based on the C&P examination, citing painful motion.  The VA found the back condition to be “not service connected.”

The panel first considered if the neck and upper back condition, having been de-coupled from the combined PEB adjudication, remained separately unfitting as established above.  The panel concluded there was not a preponderance of evidence showing that either the neck or upper back condition standing alone would have caused the CI to be referred into the Disability Evaluation System or be found unfit.  Although the MEB examination did not cite ROM measurements, the panel agreed a 10% rating was justified for the presence of painful motion, spasms and tenderness.  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.  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 and back condition.  

BOARD FINDINGS:  In the matter of the neck and back condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  There were 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 20170425, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment 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-2017-04437.

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