RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03722
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050628

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E5, Helicopter Repairer, medically separated for “chronic radiating low back pain” and “chronic neck pain,” rated 10% and 10%, respectively, with a combined disability rating of 20%.  

CI CONTENTION:  The applicant requests the Board consider all conditions.  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 - 20050505	VARD – 20060224	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Radiating Low Back Pain	5237	10%	Lumbosacral Strain 	5237	10%	20050812	
			Sciatica, Right Lower Extremity	8520	10%	20050812	
Chronic Neck Pain	5237	10%	Foraminal Stenosis, Cervical Spine	5238	0%	20050812	
Posterior Muscular Headaches	Not Unfitting 	Muscular Tension Headaches	8199-8100	0%	20050812	
Dyslipidemia	Not Unfitting	Dyslipidemia	7199-7101	NSC	20050812	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Chronic Radiating Low Back Pain (LBP).  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s LBP condition began in September 2000 after heavy lifting.  Following the acute injury the CI reported chronic LBP, which became intermittent after he reclassified to a less physically demanding military specialty.  He was deployed in May 2003 and completed his tour.  He reported his back was aggravated by individual readiness training in 2005.  A lumbar magnetic resonance imaging study showed no evidence of disk degeneration, displacement or other abnormality.  There was no surgical indication.  Despite treatment, the back condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for a MEB.  The MEB forwarded “chronic low back pain” for PEB adjudication.  At the MEB examination (recorded on DD Form 2807 and 2808) dated April 2005, 3 months prior to separation, the physical exam revealed tenderness to palpation (TTP) over the lumbosacral spine, without spasm.  Lower extremity strength and reflexes were normal and straight leg (SLR) testing (maneuver to elicit radicular symptoms).  Thoracolumbar range of motion (ROM) performed by the examiner (after repetition) was flexion 85 degrees (normal 90) and combined ROM 235 degrees (normal 240) and painful motion was noted.  The MEB NARSUM examination on 20 April 2005 (2 months prior to separation) noted complaints of frequent intermittent pain across the lower lumbar area with occasional radiation into his buttocks, with “tingling.”  The CI graded his pain 3-4/10 and it was aggravated by standing or sitting for more than an hour and twisting.  He was limited to lifting up to 50 pounds.  The physical exam recorded on the DD Form 2808 was cited 

At the VA Compensation and Pension (C&P) examination in August 2005 (2 months after separation), the CI reported daily LBP of moderate intensity which included radiating pain to both ankle areas, with a tingling.  Flare-ups occurred every 2 weeks with prolonged sitting or standing.  There had been no incapacitating episodes of LBP in the past 12 months.  Physical exam showed a normal gait.  There was no TTP or muscle spasm.  Lower extremity strength, sensation, and reflexes were normal and SLR was negative bilaterally.  Thoracolumbar ROM was flexion 90 degrees (normal 90) and combined ROM 240 degrees (normal 240), without painful motion and there was no pain or reduction in ROM after repetition.   

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under the 5237 code (lumbosacral strain), citing slight limitation of motion and tenderness.  The VA also assigned a 10% rating using the 5237 code (lumbosacral strain) based on the VA C&P examination 2 months after separation, citing daily pain with flare- ups and normal ROM. The VA assigned an additional 10% rating using the 8520 code (incomplete paralysis of the sciatic nerve, mild), citing decreased sensation in the right foot.  

The Board agreed that a 10% rating, but no higher, was justified for limitation of flexion (greater than 60 degrees but not greater than 85 degrees) and combined ROM (greater than 120 degrees but not greater than 235 degrees) reported on the MEB examination.  There was no muscle spasm or guarding severe enough to result in abnormal gait or spinal contour, thus the next higher 20% rating was not justified on this basis.  There was no evidence of intervertebral disc syndrome (IDS) resulting in incapacitating episodes requiring bed rest prescribed by a physician to warrant consideration of rating under the alternate VASRD formula based on incapacitating episodes due to intervertebral disc syndrome.  

The Board also considered if additional disability rating was justified for peripheral nerve impairment due to radiculopathy.  The CI reported radiation of pain and tingling to the lower extremities.  Radiating pain is subsumed under the general spine rating criteria, which specifically states “with or without symptoms such as pain (whether or not it radiates)” and the C&P exam noted normal lower extremity strength sensation, and reflexes.  There is no evidence in this case that a motor or sensory deficit existed to any degree that could be described as functionally impairing.  The Board therefore concluded that additional disability 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 lumbar spine condition.  

Chronic Neck Pain.  According to the STR and MEB NARSUM, the CI’s neck condition began in September 2000 after the same heavy lifting incident which provoked the LBP above.  The CI reported localized neck pain without upper extremity symptoms.  Radiographic studies March 2005 noted a history of chronic neck pain for five years and showed mild bilateral neuroforaminal narrowing at multiple cervical levels.  Conservative treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “chronic neck pain” for PEB adjudication.

At the MEB examination (recorded on DD Form 2807 and 2808) dated April 2005, 3 months prior to separation, the physical exam revealed TTP over the lower cervical spine without any spasm or deformity.  Upper extremity strength and reflexes were normal.  Cervical ROM measurements performed by the examiner were flexion 70 degrees (normal 45) and combined ROM 260 degrees (normal 340) after repetition, with painful motion.  The MEB NARSUM examination on 20 April 2005 (2 months prior to separation) noted complaints of intermittent (30% of the time) neck pain.  The CI denied any upper extremity symptoms.  His average pain level was 3/10 and was aggravated by wearing Kevlar (helmet) and bending his neck.  The physical exam recorded on the DD Form 2808 was cited 

At the VA Compensation and Pension (C&P) examination in August 2005, performed 2 months after separation, the CI reported daily neck pain which was mild to moderate in intensity with occasional pain radiating to the right shoulder.  The CI denied flare-ups and it was noted that routine activities were “not significantly affected.”  Physical exam showed no focal tenderness, There was no muscle spasm, guarding, or abnormal spinal contour.  Upper extremity strength and reflexes were normal.  Cervical ROM measurements were flexion 45 degrees (normal 45) and combined ROM 335 degrees (normal 340).  After repetition there was mild lower cervical pain with no reduction in ROM.   

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under the 5237 code (cervical spine strain), citing full ROM and tenderness.  The VA assigned a 0% rating using the 5238 code (spinal stenosis) based on the VA C&P examination 2 months after separation, citing ROM, no tenderness, spasm or abnormal spine contour.  The Board agreed that a 10% rating, but no higher, was justified for combined ROM (greater than 170 degrees but not greater than 335 degrees) reported on the MEB and VA examinations.  There was no muscle spasm or guarding severe enough to result in abnormal gait or spinal contour, thus the next higher 20% rating was not justified on this basis.  There was no evidence of IDS resulting in incapacitating episodes requiring bed rest prescribed by a physician to warrant consideration of rating under the alternate VASRD formula based on incapacitating episodes due to intervertebral disc syndrome.  

The Board also considered if additional disability rating was justified for peripheral nerve impairment due to radiculopathy.  The CI reported occasional radiating pain to the right shoulder at the C&P exam, but denied any symptoms at the MEB exam.  Upper extremity strength, sensation, and reflexes were normal at both the MEB NARSUM and C&P exams.  Radiating pain from the neck condition is subsumed under the general spine rating criteria, which specifically states “with or without symptoms such as pain (whether or not it radiates)” and there was no objective evidence of a radiculopathy with functional impairment.  The Board therefore concluded that additional disability rating was not justified on this basis 

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that occasional posterior muscular headaches and dyslipidemia were not unfitting.  The Board’s threshold for countering fitness determinations requires a preponderance of evidence, but remains adherent to the DoDI 6040.44 “fair and equitable” standard.  The headaches and dyslipidemia were not profiled or implicated in the commander’s statement and were not judged to fail retention standards.  All were reviewed and considered by the Board.  There was no performance based evidence from the record that either of these conditions significantly interfered with satisfactory duty performance.  After due deliberation, and 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 headaches or dyslipidemia contended conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the chronic radiating low back pain condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the chronic neck pain condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended occasional posterior muscular headaches and dyslipidemia conditions, the Board unanimously recommends no change from the PEB determinations as not unfitting.  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, dated 20140812, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR Commander

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation
for XXXXXXXXXXXXXXXXXXXXXXX AR20160009327 (PD201403722)

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