RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-04472
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20080518

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Personnel Craftsman, medically separated from the Temporary Disability Retired List (TDRL) for “chronic neck pain” with a disability rating of 10%. 

CI CONTENTION:  “Chronic neck pain due to degenerative disc disease, migraine headaches.”  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 - 20080407	VARD - 20070507	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Neck Pain	5243	10%	Degenerative Arthritis, Cervical Spine	5242	10%	20070130	
Migraines	Cat II	Migraine Headaches	8100	30%	20070130	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Chronic Neck Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s neck condition began in 2003 after a motor vehicle crash.  The cervical MRI showed disc bulging and osteophyte formation at C3-4 and C4-5 with cord signal changes.  Review by neurosurgery ended in a recommendation for non-surgical management, but after she moved to El Paso, Texas, she was reportedly offered surgery, but declined because there was no guarantee that it would alleviate her pain.  The CI was temporarily rated 50% for migraine headaches with cervicalgia and placed on the TDRL effective 18 October 2006.
During the 25 February 2008 MEB TDRL NARSUM examination, 3 months prior to TDRL removal, the CI reported worsening of her cervicogenic pain since her placement on the TDRL.  Physical examination showed mild tenderness, but she had full range of motion (ROM), and normal gait, motor strength, reflexes and sensation.  There was no VA examination proximate to separation in evidence.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the neck condition 10%, coded 5243 (intervertebral disc syndrome), citing good ROM of the neck.  Although there was insufficient limitation of motion noted in the examination proximate to separation to support a 10% rating, the panel agreed a 10% rating was justified based on history of chronic pain, and tenderness on the TDRL 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.  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 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.  Although the condition had previously been found unfitting and rated by the PEB at 50%, the MEB TDRL NARSUM examination noted the migraines had improved since being placed on the TDRL and only occurred one or two times per month, and were effectively aborted with Relpax.  The TDRL examiner stated, “from a migraine perspective, patient’s symptoms are presently controlled to the point that she could return to duty.”  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 neck condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended migraine headaches, the panel recommends no change from the PEB determination as not unfitting.  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:

SAF/MRB

Dear XXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-04472.

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.