RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01480
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090402

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a Reserve E6, Chaplain Assistant, medically separated for “degenerative arthritis, cervical spine” and “degenerative arthritis, lumbar spine,” rated 10% and 10%, respectively, with a combined disability rating of 20%.

CI CONTENTION:  The CI contends he was not evaluated for migraines and scoliosis.  The CI’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 - 20090204	VARD - 20090610	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Degenerative Arthritis, Cervical Spine	5242	10%	Cervical Strain…with Foraminal Narrowing	5243-5237	10%	20090331	
Degenerative Arthritis, Lumbar Spine	5242	10%	Thoracolumbar Strain with Thoracic Dextroscoliosis…	5243-5237	10%	20090331	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS: 50%	

ANALYSIS SUMMARY:  

Degenerative Arthritis, Cervical Spine.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s cervical spine condition began in 2006.  The CI denied any specific injury or trauma.  Radiographic studies performed in October 2008 revealed multiple disc bulges without herniation.  There was no surgical indication, and conservative treatment did not result in improvement sufficient to allow unrestricted duty. The MEB forwarded chronic neck pain for PEB adjudication.  The MEB NARSUM examination dated 1 December 2008 (4 months prior to separation) noted complaints of a long history of neck pain.  Physical examination revealed midline tenderness and full active range of motion (ROM) of the cervical spine.  The CI denied extension of pain and altered sensation of the upper extremities.  No periods of physician-prescribed bed rest during the previous 12 months was noted.  At the VA Compensation and Pension (C&P) examination in March 2009 (3 days before separation) the CI reported a constant 6/10 neck pain which was aggravated by physical activity and relieved with rest.  The CI denied periods of physician-prescribed bed rest during the previous 12 months.  Physical examination revealed a normal posture and gait.  There was no evidence of muscle spasm, tenderness or radiating pain on movement.  Cervical spine ROM was minimally decreased (by 5 degrees) in all maneuvers except bilateral rotation.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under 5242 (degenerative arthritis of the spine), citing flexion and combined ROM measurements.  The VA also assigned a 10% rating using an analogous 5243-5237 code (intervertebral disc syndrome and cervical strain) based on the VA C&P examination 3 days before separation, citing forward flexion greater than 30 degrees and a combined ROM greater than 170 degrees but not greater than 335 degrees.  The Board agreed that a 10% rating, but no higher, was justified for limitation of flexion (greater than 30 degrees but not greater than 40 degrees) or for the combined ROM (greater than 170 degrees but not greater than 335 degrees) reported on the VA examination as well as with the tenderness on the NARSUM examination proximate to separation.  There were no muscle spasms or guarding severe enough to result in abnormal gait or spinal contour, thus the next higher 20% rating was not justified on this basis.  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 cervical spine condition.  

Degenerative Arthritis, Lumbar Spine.  According to STR and the MEB NARSUM, the CI’s lumbar spine condition began in 2006 and was not due to injury or trauma.  Diagnostic studies performed in late 2008 noted minimal, but multi-level disc bulging of the lumbosacral spine.  Despite pain extending into both legs, electro-diagnostic studies were negative for any neuropathy.  There was no surgical indication, and conservative treatment did not result in improvement sufficient to allow unrestricted duty. The MEB forwarded chronic back pain for PEB adjudication.  At the NARSUM examination, the CI reported continued back pain.  Two epidural steroid injections helped with the pain and resolved the radiating pain into the legs.  The CI denied further peripheral numbness, tingling and bowel/bladder dysfunction.  Physical examination noted tenderness about the lumbosacral spine and also indicated a slight spinal curve.  Motor and sensory examinations were normal.  At the VA C&P examination the CI reported a constant burning, aching, sharp, and cramping low back pain that extended into both hips and legs.  His painful symptoms were aggravated by physical activity and relieved with rest.  He reported difficulties with lifting, stooping, bending, twisting, climbing stairs, and jumping.  He denied any periods of physician-prescribed bed rest during the previous 12 months.  Physical examination revealed a normal gait and posture.  There was no evidence of muscle spasms or radiating pain upon movement.  Tenderness was noted.  Lumbar spine ROM was near normal with evidence of localized painful motion.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under the 5242 code (degenerative arthritis) citing limitation of motion and mild tenderness.  The VA assigned a 10% rating using an analogous 5243-5237 code based on the VA C&P examination citing painful limited ROM.  The Board agreed that the greatest probative value be apportioned to the VA examination due to nearness to the date of separation.  The evidence of painful motion supported VASRD §4.59 for a maximum 10% impairment.  There were no physical parameters present near the time of separation to support a basis for a 20% rating.  Additionally, there was no evidence of intervertebral disc syndrome (IVDS) which resulted in incapacitating episodes requiring physician-prescribed bed rest to warrant consideration of rating under the alternate VASRD formula (for IVDS).  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 lumbar spine condition.  

BOARD FINDINGS:  In the matter of the cervical spine condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the lumbar spine 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, 20140328, 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 AR2016001 0354 (PD201401480)

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