Search Decisions

Decision Text

AF | PDBR | CY2014 | PD-2014-01529
Original file (PD-2014-01529.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXXXX       CASE: PD-2014-01529
BRANCH OF SERVICE: AIR FORCE     BOARD DATE: 20150422
SEPARATION DATE: 20090515


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-6 (Survival, Evasion, Resistance and Escape Operations Craftsman) medically separated for chronic back and neck pain. The conditions could not be adequately rehabilitated to meet the physical requirements of his Air Force Specialty or satisfy physical fitness standards. He was issued a duty limiting condition report and was referred for a Medical Evaluation Board (MEB). The back and neck conditions, characterized as “chronic neck and back pain,” were forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123. No other conditions were submitted by the MEB. The Informal PEB adjudicated “chronic thoracolumbar pain, with mild degenerative disease at L1” as unfitting, rated 10% with likely application of Veterans Affairs Schedule for Rating Disabilities (VASRD). The remaining condition was determined to be C ategory II which can be unfit, but not compensable/ratable. The CI made no appeals and was medically separated.


CI CONTENTION: “Believe all the issues resulting from the parachuting accident should be considered, if not all my service-connected conditions. Additionally, the VA increased some ratings given by the USAF. After appeal my initial rating changed to 70%.”


SCOPE OF REVIEW: The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e.(2). It is limited to those conditions determined by the PEB to be unfitting for continued military service and when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting. Any conditions outside the Board’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/Naval Records. Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate. The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the VASRD standards to the unfitting medical condition at the time of separation. The Board 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, operating under a different set of laws. The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.


RATING COMPARISON :

Service IPEB – Dated 20090410
 VA - (~5 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Chronic Thoracolumbar Pain, with Mild Degenerative Disease at L1 5243 10% Degenerative Disease At L1 With Straightening Of Lumbar Lordosis 5242 10% 20090901
Chronic Neck Pain, With Mild Degenerative Joint Disease Without Spinal
Stenosis		 5243 Cat II Degenerative Changes, Cervical Spine 5242 10% 20090901
Other x 0 (Not in Scope)
 Other x 26 20090901
Combined: 10%
 Combined: 50%
Derived from VA Rating Decision (VA RD ) dated 20091223 ( most proximate to date of separation [ DOS ] ).


ANALYSIS SUMMARY :

Chronic Thoracolumbar (TL) Pain. The narrative summary (NARSUM) notes the CI had a history of chronic back pain (BP). The back pain started in 2005 following a bad parachute jump. Following this incident the CI had back pain off and on and in July 2006 the CI experienced a thoracic spine injury at the level of the shoulder blades while lifting weights. Thoracic spine X-rays on 26 April 2007 were normal and lumbar spine X-rays noted wedging of the L1 vertebrae, which was read by the radiologist as an old injury. Thoracic spine magnetic resonance imaging (MRI) on 28 August 2007 was normal and lumbar spine MRI on 24 September noted mild degenerative joint disease without neuroforaminal or spinal stenosis. He was treated for myofascial back pain with therapy, multiple medications, and trigger point injections. The injections temporarily helped the upper back pain, but not the lower. An incomplete sentence in the NARSUM notes an MRI in February 2008 noted bulging discs, but there was no indication what segment of the spine was being addressed. There were no episodes of incapacitation due to the TL back condition noted in the records.

At the MEB examination on 17 December 2008, 4 months prior to separation, the CI reported upper back pain exacerbated by impact or pulling activities, described as tightness and moderate pain. He reported low back pain aggravated by activity that was stabbing, with burning pain and numbness of the left lower extremity (LLE), sometimes with weakness. The MEB physical exam noted a normal gait and stance with some reduced thoracic range-of-motion (ROM). Strength and reflexes of the LEs were normal. A physical therapy evaluation of the upper back on 7 April 2009 separately noted ROM of the thoracic spine and ROM of the lumbar spine. Thoracic flexion was 34 degrees with painful motion and lumbar flexion was 76 degrees with stiffness noted. The exam noted tenderness of the thoracic spine and thoracic muscle spasm.

At the VA Compensation and Pension (C&P) examination on 1 September 2009, 5 months after separation, the CI reported intermittent low back pain precipitated by bending or lifting. The CI reported that he limited bending and lifting with no effect on his work. The exam noted ROM of flexion of 85 degrees with pain and combined ROM of 220 degrees. Toe and heel walking were normal and straight leg raise testing was normal. There was no additional loss of ROM with repetition. Thoracic X-rays were normal and lumbar X-rays noted straightening of the lumbar lordosis.

The Board directed attention to its rating recommendation based on the above evidence. The PEB rated TL back pain 10%, coded 5243 (intervertebral disc syndrome) and the VA rated it 10%, coded 5242 (spinal arthritis). The Board agreed that the evidence in record supports a 10% rating for painful limited TL ROM according to VASRD rules for rating the spine in effect at the time of separation. The Board noted that the MEB examination did not provide TL ROM measured with a goniometer as specified by the VASRD. However, the noted lumbosacral ROM by itself was sufficient to remain in the 10% rating based on TL ROM according to VASRD rules for rating the spine in effect at the time of separation. The VA examiner also referred to ROM as lumbosacral and not thoracolumbar, however, the C&P ROM values were consistent with thoracolumbar ROM and met 10% rating criteria for both forward flexion and combined TL ROM. Members agreed that no higher rating could be supported based on limited ROM alone and the evidence did not provide support for the 20% rating based on muscle spasm severe enough to result in an abnormal gait or spinal contour and there were no episodes of incapacitation related to the TL back condition to provide higher rating. The Board also considered if additional disability rating was justified for peripheral nerve impairment due to radiculopathy. The CI reported symptoms of radiating LLE pain and occasional weakness; however, both the MEB and C&P examinations indicated normal strength with intact reflexes and no other neurological abnormalities. The pain component of a radiculopathy is subsumed under the general spine rating as specified in §4.71a and since no evidence of functional impairment exists in this case, the Board cannot support a recommendation for additional rating based on peripheral nerve impairment. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the TL spine condition.

Contended PEB Conditions. The Board’s main charge is to assess the fairness of the PEB’s determination that the neck condition was not unfitting. The Board’s threshold for countering fitness determinations is higher than the VASRD §4.3 (reasonable doubt) standard used for its rating recommendations, but remains adherent to the DoDI 6040.44 “fair and equitable” standard.

Neck Condition. The NARSUM noted that due to chronic neck and back pain the CI was unable to fulfill the requirements of his job title and had been on profile for his neck and back for an aggregate 8 months. As noted in the TL back condition discussion, the CI had upper and lower back problems and then in June 2008 sustained a new injury while lifting weights, which caused left side neck pain with “popping” whenever he lifted his hands above his head. The NARSUM listed a cervical MRI on 13 November 2007 (prior to the exacerbation) that noted mild degenerative disc disease, without neuroforaminal or spinal stenosis. A second cervical MRI in October 2008 reportedly showed arthritis at C3-4. Physical therapy ROM performed on 4 December 2008 reported flexion “WNL” (within normal) with “end range pain” with combined cervical ROM of 285 degrees (normal 340). At the MEB examination on 2 January 2009, 4 months prior to separation, the CI reported a chronic neck ache that radiated to the left shoulder without any upper extremity numbness, tingling, or weakness. At a pain management evaluation on 7 January 2009, 5 days after the MEB exam, the CI reported chronic neck and upper back pain which was relieved for two months by a previous trigger point injection. He reported localized neck pain without radiation. The exam noted tenderness to palpation in the middle of the neck. Arm strength and neurological exam were normal and the assessment was myofascial pain. Physical therapy ROM reported cervical flexion WNL with “end range pain” with combined cervical ROM of 285 degrees (normal 340). There were no incapacitating episodes due to the neck pain documented in the service treatment record.

The neck condition was addressed on a duty limiting condition report dated 3 October 2008. The commander’s statement did not implicate any specific medical condition and noted that the CI was able to perform his duties in-Garrison. The commander recommended the CI’s retention, but noted his profile prevented deployment. The NARSUM noted that the CI’s inability to carry weight necessary in his career field; carry weight required during deployment; and, to maintain his jump status impaired his duty performance.

The Board first turned its attention to its fitness recommendation for the neck condition. Members engaged in lengthy deliberations regarding whether there was a “preponderance of evidence” in evidence to support recommending the neck condition as unfitting at the time of separation. There was scant information available regarding either the treatment or fitness implications of the neck condition, which in itself presented an obstacle for the Board to meet the “preponderance of evidence” standard. The Board consensus was that the evidence supports that TL back condition was longstanding and had limited the CI’s duty performance prior to the neck aggravation in June 2008. Evaluations of the neck most proximate to separation provided support that the symptoms were improving following the recent exacerbation. The Board noted that the commander’s statement did not clarify the fitness issue and the CI’s limitations listed in the NARSUM could all be attributed to the TL back condition and did not necessarily implicate the neck in addition. The Board majority concluded that a preponderance of evidence in support of recommending the neck as unfitting for continued military service could not be established based upon the evidence in record. After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the neck condition and so no additional disability rating is recommended.


BOARD FINDINGS: IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB will not be considered by the Board to the extent they were inconsistent with the VASRD in effect at the time of the adjudication. The Board did not surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD were exercised. In the matter of the TL back condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication. In the matter of the contended neck condition, the Board majority recommends no change from the PEB determination as not unfitting. There were no other conditions within the Board’s scope of review for consideration.


RECOMMENDATION: The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination.


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20140228, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans Affairs Treatment Record





XXXXXXXXXXXXXXXXXXXX
President
Physical Disability Board of Review


SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD 20762


Dear XXXXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2014-01529.

         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,






XXXXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings

cc:
SAF/MRBR

Similar Decisions

  • AF | PDBR | CY2013 | PD-2013-02323

    Original file (PD-2013-02323.rtf) Auto-classification: Denied

    Cervical spine MRI on 20 January 2005 noted lower cervical spine disc herniation with spinal stenosis and general degenerative disc disease.As noted above, a note in the STR indicated “EMG/NCS-no evidence of radiculopathy.”Notes in the STR near the date of separation noted continued neck pain with intact ROM and normal strength and sensation.At the MEB examination on 27 May 2004, (approximately 5 months prior to separation)the CI reported neck pain. RECOMMENDATION : The Board, therefore,...

  • AF | PDBR | CY2014 | PD-2014-01977

    Original file (PD-2014-01977.rtf) Auto-classification: Approved

    The Informal PEB (IPEB) adjudicated “chronic neck pain” and “chronic low back pain” as unfitting, rated 10% and 0%, respectively, for a combined 10% disability, with likely reliance on AR 635-40 for rating. Disk protrusions were noted to decrease from 2005 through 2007 and the mild dilatation of the central thoracolumbar spinal canal (Syrinx) was stable.At the MEB exam, the CI reported back pain exacerbated by activity and rare left leg pain. In the matter of the back condition, the Board...

  • AF | PDBR | CY2013 | PD-2013-02730

    Original file (PD-2013-02730.rtf) Auto-classification: Approved

    Post-Separation) ConditionCodeRatingConditionCodeRatingExam Chronic Low Back Pain523710%Strain, Thoracolumbar Spine523710%20070521Other x0 (Not in Scope)Other x 6(Not in Scope)20070521 Combined: 10%Combined:50%Derived from VA Rating Decision (VARD)dated 20070618 ( most proximate to date of separation) Chronic LBP Condition . Physical therapy ROM was TL flexion of 50 degrees (normal 90 degrees) and TL combined ROM of 152 degrees (normal 240 degrees) with ROM noted to be limited by pain.At...

  • AF | PDBR | CY2012 | PD2012-00867

    Original file (PD2012-00867.pdf) Auto-classification: Denied

    Cervical Spine Pain Condition. Thoracolumbar Spine Pain Condition. At the MEB exam accomplished 5 months prior to separation, the CI reported the same history documented in the cervical spine pain condition above.

  • AF | PDBR | CY2009 | PD2009-00077

    Original file (PD2009-00077.docx) Auto-classification: Denied

    Although the VA rating exam cited above would yield a 30% rating, no repeat rating decision is in evidence. The VA rating examination 11 months later did not provide full goniometric ROM measurements for the thoracolumbar spine, stating the CI was too unsteady to cooperate with them. In the matter of the chronic neck pain condition, the Board unanimously recommends a rating of 20% coded 5242 IAW VASRD §4.71a.

  • AF | PDBR | CY2009 | PD2009-00139

    Original file (PD2009-00139.docx) Auto-classification: Denied

    The medical bases for the separation were cervical and thoracolumbar spine conditions. The CI was thus medically separated with a combined disability rating of 20%. The Board therefore recommends a 10% rating for the thoracolumbar condition and a 20% rating for the cervical condition.

  • AF | PDBR | CY2011 | PD2011-00709

    Original file (PD2011-00709.docx) Auto-classification: Denied

    The thoracolumbar spine condition was forwarded to the Physical Evaluation Board (PEB) as separate diagnoses for thoracic disc and lumbar disc disease, each judged to be medically unacceptable IAW AR 40-501. CI CONTENTION : “I was medically separated from active duty in the US Army for spinal condition, ‘Degenerative Changes and Disc Disease of the Thoracic and Lumbar Spine with Lumbar Dextroscoliosis’ which causes constant back pain which is constantly at a 7 out of 10 on pain. ...

  • AF | PDBR | CY2014 | PD2014 00906

    Original file (PD2014 00906.rtf) Auto-classification: Approved

    The VARD also noted the absence of radicular findings and no recording of ROM (the CI refused testing).The Board directs attention to its rating recommendation based on the above evidence.The PEB rated the condition for ROM limited by pain, coded 5237, and assigned a rating of 0%.The VA rated the condition under code 5242, 10% for muscle spasm.Under the applicable spine rules, a rating of 10% requires cervical spine flexion of greater than 30 degrees but less than 40 degrees or a combined...

  • AF | PDBR | CY2014 | PD2014 01910

    Original file (PD2014 01910.rtf) Auto-classification: Approved

    The MEB also identified and forwarded two other conditions (high frequency hearing loss and anxiety disorder) for PEB adjudication.The Informal PEBadjudicated left shoulder pain, neck pain and LBPas unfitting, rated 10%, 0% and 0% respectively, with likely application of the VA Schedule for Rating Disabilities (VASRD) for the neck and back condition and citing the US Army Physical Disability Agency (USAPDA) pain policy for the shoulder condition. The PEB rated the condition of chronic neck...

  • AF | PDBR | CY2011 | PD2011-00365

    Original file (PD2011-00365.docx) Auto-classification: Denied

    Degenerative joint disease of the cervical spine and mechanical low back pain were forwarded to the Physical Evaluation Board (PEB) as medically unacceptable conditions IAW AR 40-501. The Board also noted that both the PEB and VA ratings were based on this exam, and that there was no subsequent VA data within the DoDI 6040.44 prescribed 12-month period in evidence. Other PEB Conditions .