Background
Air Force veteran Carissa L. Thompson suffered an L1 vertebra burst fracture in a 2003 all-terrain-vehicle accident. An Air Force Physical Evaluation Board found her unfit for duty, assigned a 10% disability rating, and medically separated her in 2005 with severance pay. Months later, the Department of Veterans Affairs assigned a 40% rating for the same spinal injury.
Thompson sought review from the Physical Disability Board of Review, which recommended retaining the 10% rating. The Air Force accepted that recommendation. Thompson then sued under the Administrative Procedure Act, arguing that the PDBR relied on inadequate examinations, improperly discounted the VA examination, disregarded contrary range-of-motion evidence, and failed to resolve reasonable doubt in her favor. The district court granted summary judgment to the government.
The Court’s Holding
In an unpublished 2-1 decision, the Fourth Circuit affirmed. Applying deferential APA review, the majority held that the PDBR reasonably concluded that Thompson’s condition supported a 10% rating at the time of separation. The June and July 2004 reports were adequate because they documented full spinal range of motion despite pain and tightness. Although the February 2005 report was inadequate by itself for rating purposes, the court held that the PDBR could consider it as part of Thompson’s overall medical history.
The court also upheld the PDBR’s decision to give less weight to the August 2005 VA range-of-motion measurements because Thompson wore a rigid brace designed to restrict motion during that examination. It concluded that the PDBR sufficiently addressed the conflicting evidence, permissibly favored orthopedic evaluations over other reports, and had substantial evidence for finding that the record did not present reasonable doubt or more nearly approximate a higher rating.
Judge Benjamin dissented, reasoning that the PDBR improperly relied on the inadequate February 2005 report, failed to grapple with a December 2004 examination documenting only 20 degrees of forward flexion, and did not give adequate consideration to the VA’s 40% rating. She would have remanded for reevaluation by the Air Force Board for Correction of Military Records.
Key Takeaways
- An examination that is inadequate as the sole basis for a disability rating may still be considered alongside adequate examinations when the agency evaluates the veteran’s complete medical history.
- The PDBR could discount range-of-motion measurements taken while the veteran wore a brace designed to restrict motion, even though she ordinarily wore the brace daily.
- Conflicting medical evidence does not automatically trigger the benefit-of-the-doubt rule; the rule applies only when the positive and negative evidence is approximately balanced.
Why It Matters
The decision illustrates the substantial deference courts give military disability determinations under the APA. An agency need not discuss every conflicting measurement individually if its reasoning can be discerned and substantial evidence supports the weight it assigned to competing medical reports.
The case also highlights the stakes of disability ratings for medically separated servicemembers: a rating below 30% may result in severance pay rather than medical retirement and its accompanying pension and healthcare benefits.