RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02188
BRANCH OF SERVICE:  Army  	BOARD DATE:  20150505
SEPARATION DATE:  20060424

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a National Guard (temporary tour of active duty) E-5 (Aircraft Powerplant Repairer) medically separated for chronic low back and neck pain (with associated headaches) conditions.  The condition 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 U3L3E2 profile and referred for a Medical Evaluation Board (MEB).  The “lumbar spondylosis” and the “cervical spondylosis” conditions were forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB also identified and forwarded five other conditions as medically acceptable (left shoulder impingement, bilateral knee pain, left ankle pain and swelling, migraine headaches secondary to neck pain and refractive error [existed prior to service]) for PEB adjudication.  The Informal PEB (IPEB) adjudicated “chronic low back pain due to spondylosis” and “chronic neck pain due with associated headaches due to cervical spondylosis” as unfitting, rated 10% and 10% with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The remaining conditions were determined to be not unfitting.  The CI made no appeals and was medically separated.  

CI CONTENTION:  The CI elaborated no specific contention in his application.  

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 20060207	VA* - (~2 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain (LBP) due to Spondylosis	5299-5237	10%	DDD, Lumbar Spine	5243	10%	20060705	
Chronic Neck Pain w/Associated Headaches due to Cervical Spondylosis	5299-5237	10%	DDD, Cervical Spine	5243	20%	20060705	
			Headaches Secondary to Cervical Injury	8199-8100	10%	20060705	
Other MEB/PEB Conditions x 4 (Not In Scope)	Other x 7	
RATING:  20%	RATING:  40%	
*Derived from VA Rating Decision (VARD) dated 20060919 (most proximate to date of separation (DOS)).  

ANALYSIS SUMMARY:  

Chronic Low Back.  Review of the record shows that the CI had a history of LBP which existed prior to service, but was aggravated in pre-deployment training and again after he was struck by a crane hook and fell off of a helicopter while deployed.  He was evaluated in neurology on 22 July 2004 for bilateral numbness and tingling below the knees and found to have an inconsistent examination.  He was again evaluated on 22 August 2004 after he fell and aggravated his LBP.  An X-ray on 15 April 2005 showed disc space narrowing at L4-5 and L5-S1.  He was seen in neurology again on 28 June 20005 and noted to have non-persistent numbness of the arms and legs.  On examination, the neurological evaluation was normal with mild to moderate limitation in the range-of-motion (ROM) for the neck and back in all planes.  He was also tender to palpation over the cervical and lumbar spine.  An MRI on 18 July 2005 showed degenerative disc disease (DDD) at L4-5 and L5-S1 with a disc herniation at L5-S1 which did not impinge the nerve roots.  Despite medications, duty restrictions, and physical therapy (PT), he was unable to return to full duty and entered into the MEB process.  At the MEB examination on 20 December 2005, the CI reported bilateral intermittent numbness and tingling in both lower extremities and the upper extremities.  The examiner noted a reduced ROM, but did not note if it was lumbar or thoracolumbar motion.  This reduced the probative value of this examination.  The narrative summary (NARSUM) was the next day, 21 December 2005.  It noted an initial injury with LBP in 1989 (prior to service) and a second injury in September 2004 when he was hurt by the crane hook.  He reported that his neck and back pain limited his duty performance and precluded the wear of protective equipment.  He also noted headaches secondary to the neck pain, but that the neck pain, not the headaches, limited duty.  On examination, the neurological evaluation was normal with sensory changes noted in a non-anatomic distribution.  The ROM was reduced and charted below.  Painful motion and incapacitation were not documented.  

At the VA Compensation and Pension (C&P) examination performed 5 July 2006, 2 months after separation, the CI reported constant pain since the fall with flares related to activity.  He was employed as an airline mechanic and hunted and fished for recreation although the former was limited somewhat as he now had to get on his knees to skin an elk.  He reported that he took baths as it hurt to stand in the shower.  On examination, his gait was even and posture erect and no assistive devices were in use.  He sat at ease with few position changes for discomfort.  Motion was limited and painful; it is charted below.  He was tender to palpation, but spasm was not recorded.  A sign of non-organic weakness was present.  

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)	NARSUM ~4 Mo. Pre-Sep	VA C&P ~2 Mos. Post-Sep	
Flexion (90 Normal)	80	70	
Combined (240)	215	205	
Comment	Painful motion not documented	Painful motion not documented	
§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% using the codes 5299-5237 (analogous to lumbosacral strain) and 5243 (intervertebral disc syndrome), respectively.  The Board noted that absent spasm, tenderness, or guarding causing an abnormal gait or documented incapacitation, the ROM in evidence on both the NARSUM and C&P examinations supports the 10% rating adjudicated by both the PEB and VA.  The Board found no route to a higher rating.  The Board noted that the neurological examination was consistently normal and when abnormalities were documented, these were not in an anatomical pattern.  The Board concluded therefore that an unfitting radiculopathy was not present at separation and 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 LBP condition.  

Chronic Neck Pain.  The CI was evaluated for neck and head pain in 2003 after hitting his head on an aircraft strut and again in October 2004 for a headache.  As noted above, he fell off of a helicopter when hit by a crane hook.  Flexion extension X-rays on 28 June 2005 were normal other than diffuse degenerative changes.  At the MEB examination, the CI reported neck pain without further specification.  The MEB examiner noted limited ROM as charted below with 3/5 signs of non-organic pain present.  The NARSUM noted that the neck pain impaired his ability to do his job.  On examination, the neurological evaluation was normal with sensory changes noted in a non-anatomic distribution.  The ROM was reduced and charted below.  Painful motion and incapacitation were not documented.  

At the VA C&P examination performed 2 months after separation, the CI reported intermittent shooting pains from his neck to his fingertips.  He stated that he had reduced strength and had dropped his coffee cup.  As noted above, he fished and hunted for recreation and worked as an airline mechanic.  On the general part of the examination, his neck was noted to be supple and the ROM full.  The neck was noted to be symmetric and to have normal curvature.  He moved it easily in conversation, but the ROM was restricted on formal testing as noted below.  One sign of non-organic weakness was present on the examination, but the neurological examination was overall normal.  An X-ray showed minimal narrowing of the C5-6 disc space.  The examiner noted objective evidence of full ROM and that the subjective complaints did not match objective evidence.  

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)	4 Mo. Pre-Sep	NARSUM ~4 Mo. Pre-Sep	VA C&P ~2 Mos. Post-Sep	
Flex (45 Normal)	30	40	30	
Combined (340)	---	240	230	
Comment	3/5 signs of non-organic pain	AO	Examination internally inconsistent	
§4.71a Rating	20%	10%	20%	

The Board directed its attention to its rating recommendation based on the above evidence.  On the MEB examination there were signs of non-organic pain reducing the probative value of this examination.  The VA C&P examiner noted that there was objective evidence that the ROM was full as opposed to the formal measurements, reducing the probative value of this examination.  The occupation and leisure activities endorsed by the CI are more consistent with the NARSUM measurements and with the pathology in evidence.  It was therefore assigned the highest probative value for rating purposes.  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.  

Headache.  The MEB determined that the headaches were medically acceptable, but the PEB subsumed these into the unfitting neck condition.  Review of the record shows one visit specifically for headaches, almost 2 years prior to separation.  At the NARSUM, the CI reported that the headaches did not limit his duty.  The headaches were not profiled or implicated by the commander as limiting duty.  At the MEB examination, the CI denied frequent or severe headaches (DD Form 2807).  At the VA C&P examination, the CI reported headaches which lasted 48 hours and occurred twice a week.  No triggers were identified nor was there a pattern to the headaches.  The Board considered the above evidence.  There was no performance based evidence from the record that the headache condition significantly interfered with satisfactory duty performance and was a separately unfitting condition.  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 determination neck pain with headache condition and so no additional disability rating is recommended.

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 back and neck conditions and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended headache condition, the Board unanimously agrees that it cannot recommend it for additional disability rating as a separately unfitting condition.  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 20140516, 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 XXXXXXXXXXXXXXXXXXXX, AR20150015743 (PD201402188)

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