RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	    CASE:  PD-2014-01124
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20081126

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Wheeled Vehicle Mechanic) medically separated for low back pain (LBP) and neck pain.  The conditions could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS).  He was issued a permanent U3L3 profile and referred for a Medical Evaluation Board (MEB).  The “L5-S1 lumbar intervertebral disc degeneration” and “myofascial cervical spine pain” were forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  Injuries from terrorist improvised explosive device blasts” was identified by the MEB and also forwarded as failing retention standards.  The MEB also identified and forwarded one other condition (pseudo folliculitis), judged to meet retention standards, for PEB adjudication.  The Informal PEB adjudicated the low back pain and cervical spine pain conditions as unfitting, rated 10% and 10%, respectively, citing application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The PEB did not find a record of any injury from a terrorist improvised explosive device blast.  The remaining condition was determined to be not unfitting.  The CI made no appeals and was medically separated.  

CI CONTENTION:  The applicant listed the sole word “PTSD” in his application.  His complete submission is at Exhibit A.

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: 

IPEB – Dated 20080827	VA* - (~1 Week Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic LBP…	5243	10%	Mild Disc Bulge at L5-S1 with DDD	5243	10%	20081202	
Myofascial Cervical Spine…	5299-5237	10%	Neck Myalgia Related to Strain…	5237	10%	20081202	
Other MEB/PEB Conditions x 2 (Not In Scope)	Other x 0	
RATING:  20%	RATING:  20%	
*Derived from VA Rating Decision (VARD) dated 20090109 (most proximate to date of separation (DOS)).  

ANALYSIS SUMMARY:  

Low Back Pain.  The record shows that the CI was exposed to an IED blast in May 2007 with a whiplash injury to the back and neck without penetrating trauma.  The first record in evidence for LBP was a request for lumbar X-rays dated 20 November 2007 which noted the above.  The X-rays were unremarkable.  He was treated with medications and physical therapy (PT) with improvement in his symptoms, but persistent pain worsened with impact activities.  An MRI on 16 January 2008 showed a degenerative disc disease (DDD) at L5-S1 with a slight bulge.  There was neither nerve root nor cord impingement.  In physical medicine on 4 March 2008, he was noted to have spasm and painful motion, but a normal neurological examination.  He continued PT and medications, but was not able to return to full duty.  In July 2008, he was issued a permanent U3L3 profile and entered into the MEB process.  The narrative summary (NARSUM) was dated 7 August 2008, four months prior to separation.  The CI reported ongoing pain and spasm in the back and neck which were aggravated by activity.  On examination, tenderness and spasm were present, but he did not have an abnormal gait or guarding.  The range-of-motion (ROM) was painful and reduced as charted below.  Repetitive rotation to the right resulted in fatigue.  At the VA Compensation and Pension (C&P) examination performed on 2 December 2008, week after separation, the CI reported on-going pain.  On examination, the gait and posture were normal.  Spasm and tenderness were absent.  The ROM is charted below and painful.  Repetition did not result in a further limitation of motion.  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.  

Thoracolumbar ROM
(Degrees)	MEB ~4 Mos. Pre-Sep	VA C&P ~1 Week Post-Sep	
Flexion (90 Normal)	90	80	
Combined (240)	220	205	
Comment	Painful Motion	Painful Motion	
§4.71a Rating	10%	10%	

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB and VA both rated the back at 10%, coded 5243 (intervertebral disc syndrome).  The limitation in motion and painful motion both support a 10% rating.  There was no incapacitation recorded.  Nor was there an abnormal gait or posture from spasm or guarding present to support a higher rating.  The neurological examination was normal and the presence of an unfitting radiculopathy at separation is not supported.  The Board concluded therefore that this condition could not be recommended for additional disability rating.  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 chronic LBP condition.  

Neck.  The history for the neck injury is as outlined above.  The CI was treated with medications and PT for the neck with persistent pain.  An MRI of the cervical spine on 16 July 2008 was normal.  He was unable to meet duty requirements and was entered into the MEB process.  The NARSUM noted a normal neurological examination as well as spasm and tenderness of the neck.  On examination, tenderness and spasm were present, but he did not have an abnormal gait or guarding.  The neurological examination was normal.  The ROM was reduced and painful as charted below.  At the VA C&P examination, the CI reported ongoing neck pain aggravated by activity.  The neurological examination was normal.  Spasm and tenderness were absent.  Gait and posture were normal.  The ROM was reduced and painful as charted below.  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)	MEB ~4 Mos. Pre-Sep	VA C&P ~1 Week Post-Sep	
Flex (45 Normal)	40	40	
Combined (340)	240	280	
Comment	Painful Motion	Painful Motion	
§4.71a Rating	10%	10%	

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB and VA both rated the neck at 10%, coded 5237 (cervical strain) although the PEB did so analogously.  No route to a higher rating was found by the Board.  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 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.  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 chronic LBP and neck pain conditions 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 20140225, 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 XXXXXXXXXXXXXXXXXX, AR20160003616 (PD201401124)

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