RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03122
BRANCH OF SERVICE:  Army  	BOARD DATE:  20150520
SEPARATION DATE:  20070517

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5 (Tracked Vehicle Mechanic) medically separated for cervical and thoracic spine conditions.  The conditions could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty.  He was issued a permanent U3 profile and referred for a Medical Evaluation Board (MEB).  The cervical and thoracic spine conditions characterized as “cervical disc disease” and “thoracic disc disease,” were forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other conditions were forwarded for adjudication.  The Informal PEB adjudicated “C6-7 herniated nucleus pulposus (HNP), without neurologic abnormality” and “chronic thoracic back pain,” as unfitting, rated 0% each, with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  “Please consider all conditions.”

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 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:

IPEB – Dated 20070411	VA* - (~4 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Cervical Spine (C6-7 HNP)	5243	0%	Cervical Strain	5237	10%	20070920	
Chronic Thoracic Back Pain 	5299-5237	0%	Thoracic Strain	5237	10%	20070920	
Other x 0 (Not In Scope)	Other x 3	
RATING:  0%	RATING:  30%	
*Derived from VA Rating Decision (VARD) dated 20071022 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Cervical Spine (C6-7 HNP) Condition.  The records in evidence for the neck are relatively scant.  On 19 September 2005, the CI was seen in the chiropractic clinic for neck and upper back pain after a trip to FL.  On 6 December 2006, a magnetic resonance imaging (MRI) showed herniated disc at C6-7 with mild cord compression and also herniated discs at C4-5 and C5-6 without cord compression.  The CI was seen by an orthopedist on 7 February 2007 who noted that the motion of the neck was not painful, there was no spasm or tenderness, and the neurological examination was normal.  The CI was issued a U3 profile and referred for MEB.  At the MEB examination, accomplished 2 weeks later by a physician’s assistant, the CI reported a 4-year history of neck pain.  The examiner noted tenderness and spasm of the neck and reduced range-of-motion (ROM).  The narrative summary (NARSUM) was dated 15 March 2007.  On examination, the ROM was reduced as charted below.  An inclinometer was used for some of the measurements rather than a goniometer, reducing the probative value of the examination.  Also, passive measurements were recorded as unreliable, also reducing the probative value of the examination.  Tenderness, guarding, spasm, and abnormal contour were all absent.  The gait was normal.  The neurological examination was normal.  Three weeks later, the ROM measurements were obtained in physical therapy.  Again, an inclinometer was used and the passive ROM measurements were noted to be unreliable, reducing the probative value of the examination.  Tenderness and guarding were present.  At the VA Compensation and Pension (C&P) examination performed 4 months after separation, the CI denied incapacitation.  The gait and posture were normal.  Tenderness, spasm, and painful motion were absent.  The ROM was normal other than right rotation.  His pain increased with repetition, but no further reduction in ROM was present.  The neurological examination was normal and signs of intervertebral disc syndrome were absent.  The 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 Mo. Pre-Sep	PT ~1 Mo. Pre-Sep	VA C&P ~4 Mo. Post-Sep	
Flex (45 Normal)	40	45	45	
Combined (340)	260	280	320	
Comment	Inclinometer/Goniometer	Inclinometer/Goniometer	Goniometer	
§4.71a Rating	10%	10%	10%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the neck at 0% using the code 5243 (intervertebral disc syndrome).  The VA rated the neck at 10% using the code 5237 (cervical or lumbosacral strain).  The Board determined that the VA examination had the highest probative value as both PEB examinations were accomplished, in part, with an inclinometer and both noted that passive ROM measurements were unreliable.  This did not impact the rating for the neck though as all support a 10% rating.  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 neck condition retaining the 5243 code.  The evidence does not support the presence of an unfitting radiculopathy at separation.

Chronic Thoracic Back Pain Condition.  The record shows that the CI was first seen for upper back pain on 11 May 2005.  X-rays were suggestive of a thoracic scoliosis (abnormal curvature) which was excluded in a formal scoliosis survey that same day.  The CI was seen intermittently over the next 18 months for recurrent pain and treated with duty restrictions and medications.  On 4 December 2006, an MRI showed degenerative disc disease at multiple levels without nerve impingement.  At the MEB examination, tenderness and decreased ROM were noted.  The NARSUM recorded that the CI had not missed work secondary to his back pain other than for medical appointments.  Tenderness, guarding, spasm, and abnormal contour were all absent.  The gait was normal.  The neurological examination was normal.  Again, an inclinometer was used for part of the ROM measurements and the passive ROM measurements were unreliable.  At the VA C&P examination performed 4 months after separation, the CI denied incapacitation.  The gait, posture, and neurological examinations were normal.  X-rays were normal.  Repetition caused increased pain without further loss 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 Mo. Pre-Sep	PT ~1 Mo. Pre-Sep	VA C&P ~4 Mo. Post-Sep	
Flexion (90 Normal)	60	50	80 w/pain	
Combined (240)	210	175	210	
Comment	Inclinometer/Goniometer	Inclinometer/Goniometer	Goniometer	
§4.71a Rating	20%	20%	10%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the back at 0% using the code 5299-5237 (analogous to cervical or lumbosacral strain).  The VA rated the back at 10% using the code 5237.  The Board determined that the VA examination had the highest probative value as both PEB examinations were accomplished, in part, with an inclinometer and both noted that passive ROM measurements were unreliable.  The VA examination was also consistent with the recorded pathology, normal gait, and normal contour.  This examination supports a 10% rating.  The Board again noted that the presence of an unfitting radiculopathy at separation is not supported.  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 upper back 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 neck (C6-7 HNP) condition, the Board unanimously recommends a disability rating of 10%, coded 5243 IAW VASRD §4.71a.  In the matter of the chronic thoracic back pain condition, the Board unanimously recommends a disability rating of 10%, coded 5299-5237 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION:  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	
C-6-7 HNP without Neurological Abnormality	5243	10%	
Chronic Thoracic Back Pain…	5299-5237	10%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140701, 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 XXX, Arlington, VA 22202-3557

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation
for XXXXXXXXXXXXXXXXXXXXX, AR20160003050 (PD201403122)

1. 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,
accept the Board's recommendation to modify the individual's disability rating to 20%
without re-characterization of the individual's separation. This decision is final.

2. I direct that all the Department of the Army records of the individual concerned be
corrected accordingly no later than 120 days from the date of this memorandum.

3. I request that a copy of the corrections and any related correspondence be provided
to the individual concerned, counsel (if any), any Members of Congress who have
shown interest, and to the Army Review Boards Agency with a copy of this
memorandum without enclosures.

BY ORDER OF THE SECRETARY OF THE ARMY:

CF:
( ) DoD PDBR
( ) DVA