RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01110
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060803

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4, Avionics System Repairer, medically separated for “chronic neck pain due to cervical stenosis and spondylosis without neurologic abnormality” and “chronic back pain without neurologic abnormality,” rated 10% and 10%, respectively, with a combined disability rating of 20%.  

CI CONTENTION:  The applicant makes no specific contention in the application.  The applicant’s complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited 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 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 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 Veterans Affairs Schedule for Rating Disabilities (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 PEB - 20060607	VARD - 20061208	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Neck Pain due to Cervical Stenosis and Spondylosis Without Neurologic Abnormality 	5238	10%	Degenerative Disk Disease with Chronic Cervical Muscle Strain 	5237	10%	20061023	
Back Pain Without Neurologic Abnormality	5299-5237	10%	Degenerative Disk Disease and Degenerative Joint Disease, Lumbar Spine	5003-5243	10%	20061023	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Neck Pain due to Cervical Stenosis and Spondylosis without Neurologic Abnormality.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s neck pain condition began in February 2006.  The CI denied any specific injury or trauma.  A magnetic resonance imaging (MRI) study in February 2006 showed diffuse stenosis from C3-T1 with no specific disc bulges.  The CI underwent physical therapy and activity modification without pain resolution.  At the NARSUM physical examination performed 3 months prior to separation there was no evidence of cervical radiculopathy.  At the VA Compensation and Pension (C&P) examination in October 2006, performed 3 months after separation, the CI reported neck pain 3-4 times a week, lasting about 2-3 hours, and eased with rest.  The physical examination showed tenderness to palpation of the cervical paralumbar muscles, no evidence of muscle spasm, and no change in spinal contour.  Gait and posture were normal.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under the 5238 code (spinal stenosis), citing tenderness.  The VA also assigned a 10% rating under the 5237 code (cervical strain), based on the VA C&P examination 3 months after separation, citing combined ROM of the cervical spine greater than 170 degrees, but not greater than 335 degrees.  The Board agreed that a 10% rating, but no higher, was justified for combined ROM of the cervical spine greater than 170 degrees, but not greater than 335 degrees.  In considering other pathways to a higher rating, it was noted that an abnormal spinal contour secondary to muscle spasms was present on a February 2006 MRI, but normal spinal contour was present at both the NARSUM and VA exams.  The Board concluded that this was not a sufficient basis for a 20% rating (i.e. for muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis).  There was no evidence of intervertebral disc syndrome resulting in incapacitating episodes requiring bed rest prescribed by a physician to warrant consideration of rating under the alternate VASRD formula based on incapacitating episodes due to intervertebral disc syndrome.  There was no evidence of an unfitting radiculopathy for consideration of a separate peripheral nerve rating.  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 neck condition.  

Back Pain without Neurologic Abnormality.  According to STR and the NARSUM, the CI’s lower back pain began in February 2006.  The CI denied any specific injury or trauma.  An MRI study in February 2006 showed a small lumbosacral disc protrusion and degenerative disc disease (DDD).  The CI underwent physical therapy without pain resolution.  The NARSUM physical examination performed 3 months prior to separation showed negative lower extremity radicular testing and 5/5 muscle strength.  At the VA C&P examination the CI reported a constant, sharp 3/10 lower back pain with weekly lower extremity numbness.  He reported pain exacerbations to 6/10, 4 times a week on prolonged with sitting 2-4 hours, and eased with rest.  The physical examination showed tenderness to palpation of the paralumbar muscles, a normal gait, no evidence of muscle spasm, no change in spinal contour, and negative radicular testing bilaterally.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under the analogous 5299-5237 code (analogous to lumbosacral strain), citing pain limited motion and localized tenderness.  The VA also assigned a 10% rating under the analogous 5003-5243 code (degenerative arthritis-intervertebral disc disease), based on the VA C&P examination citing functional loss due to pain and tenderness.  The Board agreed that a 10% rating, but no higher, was justified for a combined ROM greater than 120 degrees, but not greater than 235 degrees reported on the NARSUM examination.  There was no muscle spasm or guarding severe enough to result in abnormal gait or spinal contour, thus the next higher 20% rating was not justified on this basis.  There was no evidence of intervertebral disc syndrome resulting in incapacitating episodes requiring bed rest prescribed by a physician to warrant consideration of rating under the alternate VASRD formula based on incapacitating episodes due to intervertebral disc syndrome.  There was no evidence of an unfitting radiculopathy for consideration of a separate peripheral nerve rating.  

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 back condition.  

BOARD FINDINGS:  In the matter of the neck condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the back 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.  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 20140221, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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 XXXXXXXXXXXXXXXXXXXXXXX AR20160005844  (PD201401110)

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:

 
Enclosure

CF:
( ) DoD PDBR 
( ) DVA