SAF/MRBD (PDBR)
3351 Celmers Lane
JBA NAF Washington, MD 20762-6435

MEMORANDUM FOR THE DIRECTOR, AIR FORCE REVIEW BOARDS AGENCY

SUBJECT:  Physical Disability Board of Review Recommendation on XXXXXXXXXXXXX
	Case Number PD-2018-00486

	In accordance with Title 10 § 1554a and in compliance with DoDI 6040.44, the Physical Disability Board of Review (PDBR) adjudicated the disability rating accompanying the medical separation of the covered individual from the United States Air Force.  After carefully reviewing the application and medical separation case file, the PDBR recommended no re-characterization of the separation or modification of the disability rating previously assigned.  I recommend you accept this proposed decision.

The covered individual (CI) was a Reserve O3, Helicopter Pilot, medically separated for “cervical myofascial pain syndrome” with a disability rating of 20%.  With headaches and radiculopathy subsumed, the PEB analogously coded 5237 (cervical strain).  There was no VA examination proximate to separation in evidence.  The panel first considered if each of the bundled cervical myofascial pain syndrome, headaches and radiculopathy conditions, having been de-coupled from the combined PEB adjudication, remained separately unfitting.  The profile noted physical limitations of no running, push-ups, crunch assessment, and no unit PT, no heavy machinery use due to drowsiness caused by medications, and the CI was not worldwide deployable.  The commander’s statements implicated chronic pain without specifically identifying the CI’s medical condition.  The panel concluded there was not a preponderance of evidence in record to overcome the presumption that each of the bundled conditions was reasonably considered unfitting and eligible for individual disability rating.  

With regard to the cervical myofascial pain syndrome with degenerative disc disease, the panel agreed that a 10% rating, but no higher, was justified for limitation of flexion (greater than 30 degrees but not greater than 40 degrees) and combined ROM (greater than 170 degrees but not greater than 335 degrees) as reported on the August 2005 orthopedic examination, or cervical tenderness as reported on the MEB NARSUM and orthopedic examinations proximate to separation.  

With regard to the headaches, rating guidance under diagnostic code 8100 (migraines) is based on the frequency of “prostrating attacks” over the “last several months.”  The VASRD does not further define prostrating attacks, however commonly accepted definitions include “utter physical exhaustion or helplessness” (Webster's New World Dictionary of American English), “complete physical or mental exhaustion” or “extreme exhaustion or powerlessness” (Dorland's Illustrated Medical Dictionary).  The panel carefully considered the frequency and nature of the CI’s HAs including objective evidence and corroborating subjective evidence.  Earlier in the course of treatment the CI reported he was able to continue work with headaches and later noted that with severe headaches he had been incapacitated.  More proximate to separation, the CI reported that since on his current medication, he had no severe headaches.  The panel agreed no higher than a 0% rating, coded 8199-8100 was supported for the headaches condition.  

With regard to the radiculopathy, the CI was diagnosed with cervical radiculopathy of the right arm.  Pain, whether it radiates or not, is subsumed IAW VASRD §4.71a in the panel’s rating recommendation for the cervical spine condition above.  The panel concluded there were non-specific neurologic findings of the right upper extremity regarding a radiculopathy and no higher than a 0% rating was supported for cervical radiculopathy, coded 8510 (upper radicular group, shoulder and elbow movements).  

After unbundling the three conditions, the panel’s rating recommendations of 10% for the cervical spine, 0% for the headaches, and 0% for the radiculopathy resulted in no ratings benefit for the CI and therefore no change to the PEB’s combined adjudication is recommended.  The panel parenthetically noted that if the CI’s condition was alternatively left bundled and rated under 5025, analogous to fibromyalgia, as supported by the rheumatology examination, a 20% rating and no higher was supported for chronic myofascial pain present more than one-third of the time, and not refractory to treatment.  Although this uses a different code than the PEB, it also provides no ratings benefit to the CI, and therefore no change to the PEB’s coding choice or adjudication is recommended.  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 cervical myofascial syndrome.  

SAF/MRB
3351 Celmers Lane
JBA NAF Washington, MD 20762-6435

Dear XXXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2018-00486.

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 rating modification or re-characterization 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 modification of your disability rating or characterization of your separation is not warranted.  Accordingly, I accept the recommendation that your application be denied.