RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXX	CASE:  PD-2014-00740
BRANCH OF SERVICE:  Army	BOARD DATE:  20141203
SEPARATION DATE:  20070301

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a Reserve SPC/E-4 (37F10/Operations Specialist) medically separated for low back and neck pain.  The conditions could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards.  He was issued a permanent U3/L3 profile and referred for a Medical Evaluation Board (MEB).  The low back and neck conditions, characterized as “mechanical low back pain” and “mechanical neck pain,” were forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB also identified and forwarded three other conditions (migraines, alcohol abuse and adjustment disorder) for PEB adjudication.  The Informal PEB adjudicated “chronic mechanical low back pain” and “chronic mechanical neck pain” as unfitting, rated 10% and 10%. The remaining conditions were determined to meet retention standards.  The CI made no appeals and was medically separated.

CI CONTENTION:  “Attached with this application, you will find VA Rating Decision Dated 8 June 2005 detailing XXXXX receiving a VA disability percentage of 20% for his chronic cervical muscle spasms. Additionally, he received an initial 40% for his Low Back Pain. Both of these conditions were rated at 10% individually by the Army. This decision clearly shows his conditions as significantly more severe than Army findings.”

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 those conditions identified but not determined to be unfitting by the PEB when specifically requested by the CI.  The ratings for the unfitting low back and neck conditions are addressed below; and, no additional conditions are within the DoDI 6040.44 defined purview of the Board.  Any conditions or contention not requested in this application, or otherwise outside the Board’s defined scope of review, remain eligible for future consideration by the Board for Correction of Military Records.

RATING COMPARISON:

Service Admin IPEB – Dated 20070123	VA - (22 Mos. Pre-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Mechanical Low Back Pain	5237	10%	Low Back Pain w/ Limited Motion	5237	40%	20050421	
Chronic Mechanical Neck Pain	5237	10%	Chronic Cervical Muscle Spasms w/ Limited Motion	5237	20%	20050421	
Other x 3  (Not in Scope)	Combined:  100%	
Combined:  20%		
Derived from VA Rating Decision (VARD) dated 20050526 (most proximate to date of separation)
VARD 17 months post-separation dated 20080819 maintained the same ratings, effective 20041106 

ANALYSIS SUMMARY:

Low Back Pain Condition.  While deployed to Iraq in May 2004, the CI was involved in an improvised explosive device blast incident while he was standing in the turret of a vehicle.  The blast caused him to be thrown backwards against the turret, resulting in injury to his low back.  He completed the mission and the tour.  At the VA Compensation and Pension (C&P) exam performed 22 months prior to separation, the CI reported constant, sharp low back pain that was exacerbated by sitting for two hours or any lifting.  Examination showed an erect posture and stable gait.  Lumbar spine X-rays were normal.

The narrative summary (NARSUM) on 19 October 2006 (4 months prior to separation) reported 6 hours per day of right lower back pain made worse by sitting 6-8 hours and improved with walking.  Examination noted a symmetric and aligned spine.  Gait was normal and muscle spasm was absent.  The goniometric range-of-motion (ROM) evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.

Thoracolumbar ROM
(Degrees)	VA C&P ~ 22 Mos. Pre-Sep	PM&R ~4.5 Mos. Pre-Sep	MEB ~ 4.5 Mos. Pre-Sep	
Flexion (90 Normal)	40	90	75 (75/76/76)	
Combined (240)	150	N/A	N/A	
Comment	+Painful motion, tenderness	+Tenderness	+Painful motion, tenderness	
§4.71a Rating	20% (VA 40%)	10%*	10% (PEB 10%)	
*Conceding functional loss or painful motion

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under the code 5237 (lumbosacral or cervical strain), while the VA rated the condition 40%, also coded 5237.  The Board agreed that a 20% rating was appropriate for lumbar flexion noted on the VA exam (flexion greater than 30 but not greater than 60 degrees).  A 10% rating was correct based on the exams (conceding VASRD §4.40 or §4.59 [functional loss, painful motion], or for flexion greater than 60 degrees but not greater than 85 degrees).  Because the exams were considerably more proximal to the time of separation than the VA exam (and therefore more reflective of the condition’s status at the time of separation), the Board assigned higher probative value to the data.  As previously elaborated, the exams supported a 10% rating.  There was no evidence of muscle spasm or guarding severe enough to result in abnormal gait or spinal contour; thus, the next higher 20% rating was not warranted on this basis.  The Board also concluded that clinical evidence did not support rating intervertebral disc disease under the alternative formula for incapacitating episodes.  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 chronic mechanical low back pain condition.

Neck Condition.  The CI sustained a neck injury during the same event in 2004 that caused his back condition.  An undated clinical note after the event described a “whiplash type” injury.  At the VA C&P exam (performed 22 months prior to separation), the CI reported a constant pain made worse by extremes of ROM.  Running or lifting exacerbated his pain.  Examination showed an erect posture and stable gait.  Mild tenderness and mild spasm were noted, but spine contour was not mentioned.  Cervical spine X-rays showed no bone or disc space abnormalities.

The NARSUM (4 months prior to separation) the CI reported one hour per day of sharp stabbing pain in the mid-cervical spine area.  Pain “improved with time” or medication.  Examination noted a symmetric and aligned spine.  Gait was normal and there was no spasm.  The goniometric ROM evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.

Cervical ROM
(Degrees)	VA C&P ~ 23 Mos. Pre-Sep	MEB ~ 4.5 Mos. Pre-Sep	
Flex (45 Normal)	30*	35 (35/33/35)	
Combined (340)	210	240	
Comment	+Painful motion	+Painful motion, tenderness	
§4.71a Rating	20% (VA 20%)	10% (PEB 10%)	
	                         * Measurement was higher prior to repetitive motion

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under code 5237 (lumbosacral or cervical strain), while the VA rated the condition 20% under the same code.  As noted previously, the exam held preponderant probative value in the Board’s deliberations.  A 10% rating, but no higher, was justified in this case for forward flexion greater than 30 degrees but not greater than 40 degrees; or combined ROM greater than 170 degrees but not greater than 335 degrees.  There was no evidence of muscle spasm or guarding severe enough to result in abnormal gait or spinal contour; thus, the next higher 20% rating was not warranted on this basis.  Rating intervertebral disc disease under the alternative formula for incapacitating episodes was not clinically supported.  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 chronic mechanical neck pain condition.

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.  In the matter of the chronic mechanical low back pain condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the chronic mechanical neck pain condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  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 20140205, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

		

SAMR-RB									

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXXXX, AR20150007099 (PD201400740)

I have reviewed the enclosed Department of Defense Physical Disability Board of Review (DoD PDBR) recommendation and record of proceedings pertaining to the subject individual.  Under the authority of Title 10, United States Code, section 1554a,   I accept the Board’s recommendation and hereby deny the individual’s application.  
This decision is final.  The individual concerned, counsel (if any), and any Members of Congress who have shown interest in this application have been notified of this decision by mail.

 BY ORDER OF THE SECRETARY OF THE ARMY:

Encl						
						         
CF: 
(  ) DoD PDBR
(  ) DVA