RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-05142
BRANCH OF SERVICE:  AIR FORCE 	SEPARATION DATE:  20051109

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

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 - 20050921	VARD - 20060926	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Neck Pain 	5243	10%	Cervical Strain with Cervical Disc Disease	5237	20%	20060919	
Chronic Lower Back Pain	5243	10%	Mechanical Lumbar Strain	5237	10%	20060919	
Obstructive Sleep Apnea 	Cat II	Sleep Apnea	6847	50%	20060919	
Supraventricular Tachycardia	Cat II	Paroxysmal Supraventricular Tachycardia	7010	10%	20060919	
Hypertension	Cat II	Hypertension	7101	0%	20060919	
Allergic Rhinitis	Cat II	Perennial Allergic Rhinitis	6522	NSC	20060919	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  90% 	

ANALYSIS SUMMARY:  

Chronic Neck Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s neck condition began in 1997.  The condition had been treated conservatively over time.  An MRI of the cervical spine on 15 June 2005, showed a disc protrusion at C5-6 causing a mild degree of canal stenosis, but no significant neuroforaminal narrowing was seen.

The physical therapy examiner on 4 May 2005, 6 months prior to separation, measured the cervical range of motion (ROM) flexion as 45 degrees (normal), a T1 of 5 degrees and a “true” ROM of 40 degrees.  ROMs for extension, right and left ‘side tilts’ and right and left rotation were also recorded in this manner rather than the goniometric thoracolumbar ROM specified by the VASRD (§4.71a, Plate V).  During the 21 July 2005 MEB NARSUM examination, 4 months prior to separation, the examiner recorded pain with motion and tenderness to the cervical spine.

At the 19 September 2006 VA Compensation and Pension (C&P) evaluation, 10 months after separation, the CI reported intermittent upper extremity radiculopathy with numbness, tingling and paresthesias.  ROM showed flexion of 40 degrees and a combined ROM of 225 degrees.  

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 forward flexion of 45 degrees and observations during a formal hearing.  The VA rated the chronic neck condition 20%, coded 5237 (cervical strain), citing decreased ROM, flexion to 35 degrees with pain beginning at 20 degrees and combined ROM of 225 degrees.  The panel noted the cervical ROM of the VA examination was performed in a manner specified by the VASRD and gave it more probative value in comparison to the Service examinations.  Forward flexion and combined ROM during that evaluation supports a 10% disability rating.  The panel noted that the 20% VA rating was for pain starting at 30 degrees, not the actual flexion which was 40 degrees.  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.  

Chronic Lower Back Pain.  According to the STR and the MEB NARSUM, the CI’s back condition began in 2002 and was aggravated by running, push-ups and sit-ups.  An MRI of the lumbar spine on 15 June 2005 showed a broad-based disc bulge without significant canal stenosis or neural foraminal narrowing.  Neurosurgery and spine surgery indicated he was not a surgical candidate.  The physical therapy examiner on 4 May 2005, 6 months prior to separation, measured the “trunk” ROM of flexion as 75 degrees, a T1 of 20 degrees and a “true” ROM of 55 degrees.  ROMs for extension, right and left ‘side bends’ were also recorded in this manner rather than the goniometric method.  Right and left rotation were not recorded.  At the 21 July 2005 MEB NARSUM examination, 4 months prior to separation, the examiner noted a normal gait, no tenderness and a normal strait leg raise test.  

At the 19 September 2006 C&P evaluation, 10 months after separation, the CI reported stabbing pain in the lumbar region with weekly flare-ups lasting one to two days but did not indicate incapacitation.  The examiner noted a normal posture and gait.  ROM measurements showed flexion to 90 degrees (normal), and a combined ROM of 240 degrees (normal).  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, coded 5243 (intervertebral disc syndrome), citing limitation of motion to 75 degrees and observations during a formal hearing.  The VA also rated the back condition 10%, coded 5237 (lumbar spine strain), citing slight decrease in ROM with pain at 75 degrees.  The panel noted the thoracolumbar ROM of the VA examination was performed in a manner specified by the VASRD and gave it more probative value in comparison to the Service examinations.  Forward flexion and combined ROM during that evaluation did not support a rating higher than the 10% rating adjudicated by the PEB.  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.  

Contended PEB Conditions:  Obstructive Sleep Apnea, Supraventricular Tachycardia, Allergic Rhinitis and Hypertension.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  None of the conditions were profiled, implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that any of the conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions and so no additional disability ratings are 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 back condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended obstructive sleep apnea, supraventricular tachycardia, hypertension and allergic rhinitis, the panel recommends no change from the PEB determinations 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:

Exhibit A.  DD Form 294, dated 20170614, 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-2017-05142.

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