RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03115
BRANCH OF SERVICE:  NAVY	SEPARATION DATE:  20080530

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (MK6 4D Digital Dead Reckoning Trace Technician; Stabilized Glide Slope Indicator System Maintenance and Integrated Voice Communications Technician) medically separated for thoracic spine pain condition, rated at 0%.  

CI CONTENTION:  Please consider all conditions.

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  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 condition 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 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 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 FPEB – Dated 20080313	VA* - (~7 Mos. Pre-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Thoracic Spine Pain…	5242	0%	Lumbar Spine Musculoligamentous Sprain…	5237	10% 	20071108	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 3	
RATING:  0%	RATING:  20%	
*Derived from VA Rating Decision (VARD) dated 20080709 (most proximate to date of separation [DOS])

ANALYSIS SUMMARY:  

Thoracic Spine Condition.  Shortly after recruit training, the CI developed upper back pain after lifting another person on his shoulders during a military training session.  He described no radicular symptoms extending into any extremity.  Serial radiographs revealed no bony abnormalities of the thoracic and lumbar spine.  Specialty consultations did not recommend surgical intervention.  He received conservative treatments to include medication, physical therapy, manipulation, local injections, massage, and pain management.  Despite aggressive pain control measures, his pain continued and eventually was sent to a Medical Evaluation Board (MEB).  At the MEB narrative summary (NARUM) examination (10 September 2007; 9 months pre-separation), the CI reported feeling like his back is in severe muscle spasms all the time.  His physical examination revealed upper back tenderness.  All other physical exam parameters were normal.  The examiner’s diagnosis was listed as ‘thoracic spine pain refractory to all nonsurgical treatments.’  The commander’s statement clearly noted that the back condition prevented the CI from performing his normal physical fitness activities and limited his assignability to military duties.

At the VA Compensation and Pension (C&P) General examination (08 November 2007; 7 months pre-separation), the CI reported constant pain of the right upper thoracic spine whereby activities of daily living such as self-dressing, shopping, driving, and carrying his child caused painful 3/10 flare-ups.  Worsening pain of 7/10 occur with sitting or standing for greater than 30 minutes and lifting 20 pounds.  He denied any incapacitating episodes over the prior 12 month period.  His physical exam revealed painful motion and tenderness about the upper thoracic spine.  His diagnosis remained unchanged.

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)	MEB NARSUM
~9 Mo. Pre-Sep
(20070910)	VA C&P General
~7 Mo. Pre-Sep
(20071108)	
Flexion (90 Normal)	90	90	
Extension (30)	(30) 40	30	
R Lat Flexion (30)	(30) 45	30	
L Lat Flexion (30)	(30) 45	30	
R Rotation (30)	(30) 75	30	
L Rotation (30)	(30) 75	30	
Combined (240)	240	240	
Comment	Tenderness	Painful motion; tenderness;	
§4.71a Rating	10%	10%	

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB rated the back condition as a thoracic issue and rated 0% under code 5242 (Degenerative arthritis) citing chronic pain with no objective evidence.  The VA rated the condition as a lumbar issue at 10% under code 5237 (Lumbosacral strain) citing limited motion.  Board members first agreed that sufficient evidence of painful motion and or tenderness was present in support of a 10% impairment rating in the charted examinations.  The Board then considered application of §4.40, which allows for a higher rating if evidence of additional functional loss is present.  Member’s concluded however that there was no examination in evidence on which to base a conclusion that repetitive motion resulted in any additional disability.  There was no evidence of incapacitating episodes of at least two weeks duration secondary to intervertebral disc syndrome.  Additionally, there was no evidence of a radiculopathy that interfered with performance of military duties.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (Reasonable doubt), the Board recommends a disability rating of 10% for the thoracic spine 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.  As discussed above, PEB’s likely reliance on DoDI 1332.39 for rating the thoracic spine condition was operant in this case and the condition was adjudicated independently of that instruction by this Board.  In the matter of the thoracic spine condition, the Board unanimously recommends a disability rating of 10%, coded 5242 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.

The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation:

CONDITION	VASRD CODE	RATING	
Thoracic Spine Pain	5242	10%	
RATING	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140628, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

MEMORANDUM FOR COMMANDER, NAVY PERSONNEL COMMAND
	         DEPUTY COMMANDANT, MANPOWER & RESERVE AFFAIRS
	                          
Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS

Ref:  (a) DoDI 6040.44
	(b) PDBR ltr dtd 29 Apr 16 ICO XXXXXXXXXXXXXXX
	(c) PDBR ltr dtd 26 Jan 16 ICO XXXXXXXXXXXXXXX
	(d) PDBR ltr dtd 22 Jan 16 ICO XXXXXXXXXXXXXXX
	(e) PDBR ltr dtd 29 Apr 16 ICO XXXXXXXXXXXXXXX
	(f) PDBR ltr dtd 12 Apr 16 ICO XXXXXXXXXXXXXXX
	(g) PDBR ltr dtd 29 Apr 16 ICO XXXXXXXXXXXXXXX
	(h) PDBR ltr dtd 25 Jan 16 ICO XXXXXXXXXXXXXXX
	(i) PDBR ltr dtd 15 Apr 16 ICO XXXXXXXXXXXXXXX

1.  Pursuant to reference (a), the recommendations of the Physical Disability Board of Review set forth in references (b) through (XX) are approved.

2.  The official records of the following individuals are to be corrected to reflect the stated disposition:

     a. XXXXXXXXXXXXXXX, former USN: Entitlement to disability separation pay with a 10 percent disability rating (increased from 0 percent) effective date of discharge.

     b. XXXXXXXXXXXXXXX, former USN: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge.

     c. XXXXXXXXXXXXXXX, former USN: Entitlement to disability separation pay with a 10 percent disability rating (increased from 0 percent) effective date of discharge.

     d. XXXXXXXXXXXXXXX, former USMC: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge.
     
     e. XXXXXXXXXXXXXXX, former USMC: Retroactive placement on the Permanent Disability Retired List with a 30 percent disability rating (increased from 10%) effect date of discharge.
 
     f. XXXXXXXXXXXXXXX, former USMC: Entitlement to disability separation pay with a 20 percent disability rating (increased from 0 percent) effective date of discharge.

     g. XXXXXXXXXXXXXXX, former USN: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge.
     h. XXXXXXXXXXXXXXX, former USN: Entitlement to disability separation pay with a 10 percent disability rating (increased from 0 percent) effective date of discharge.

3.  Please ensure all necessary actions are taken to implement these decisions, including the recoupment of disability severance pay, if warranted, and notification to the subject members once those actions are complete.