RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03756
BRANCH OF SERVICE:  Army  	SEPARATION DATE:  20080813

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Initial Entry Trainee, medically separated for “cervicalgia” and “low back pain (LBP),” rated 10% and 10%, respectively, with a combined disability rating of 20%.

CI CONTENTION:  The CI requests the Board consider all conditions.  His 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:  

SERVOCE PEB - Dated 20080721	VARD - 20091022	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Cervicalgia	5237	10%	Cervicalgia Including Minor Degeneration of the Apohyseal Joint at C5-6	5237	20%	20091022	
Low Back Pain	5237	10%	Low Back Pain…Disc Bulges at L4-5 and L5-S1	5237	40%	20091022	
Left Shoulder	Not Unfitting	Left Shoulder Impingement and Joint Pain	5201	10%	20091022	
COMBINED RATING:  20%	COMBINED RATING:  60%	

ANALYSIS SUMMARY:  

Cervical Spine Condition.  The CI insidiously developed neck pain in late 2007 with extension into his shoulders without radiation into the upper extremities.  Diagnosed with cevicalgia, he received conservative treatment to include non-steroidal pain medications and manipulations.  He was permanently profiled in May 2008 with both neck and back conditions and was referred to a Medical Evaluation Board (MEB).  At the MEB narrative summary (NARSUM) examination on 8 May 2008 (3 months pre-separation), the CI’s chief complaint was chronic neck pain.  His physical examination (PE) revealed tenderness about the cervical spine.  There was full range of motion (ROM) of the cervical spine.  No spasms were in evidence and there was no comment regarding painful motion.  His diagnosis remained chronic cervicalgia with no hard findings on examination or X-rays except a mild degenerative process.  At the VA Compensation and Pension (C&P) examination on 22 October 2009 (14 months post-separation), the CI endorsed worsening neck pain with occasional ‘numbness’ extending into his arms and fingers.  His PE revealed painful and decreased ROM of the cervical spine.  He demonstrated ‘marked’ guarding with cervical motion.  There were no abnormalities of sensory, motor, or associated reflexes of the cervical spine.  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)	PT ~3 Mo. Pre-Sep	MEB/ORTHO ~ 1 Mo. Pre-Sep	
Flex (45 Normal)	40 (42,42,42)	45	
Extension (45)	45 (54,58,54)	35	
R Lat Flexion (45)	45 (44,48,48)	30 (29)	
L Lat Flexion (45)	45 (58,58,60)	30 (32)	
R Rotation (80)	60 (58,56,60)	65	
L Rotation (80)	75 (72,74,76)	80	
Combined (340)	310	185	
Comment	Inclinometer Used	Painful Motion	
§4.71a Rating	10%	10%	

The Board directed its attention to its rating recommendation based on the above evidence.  Both the PEB and VA coded the neck condition 5237 (cervical strain) and rated 10% and 20%, respectively, citing limited motion.  In regards to examination probative value, Board members focused their attention to the physical therapy and orthopedic evaluations at 3 and 1 month prior to separation.  The VA examination was outside the time frame of this Board’s purview and therefore, was not utilized in a rating recommendation.  Members acknowledged that physical therapy performed ROM measurements using an inclinometer and did not specify the placement of the device or whether a dual inclinometer method was used.  Although the Board considered the measurements, they note that their performance methodology did not conform to the VASRD rating formula which is based on goniometric measurements of motion.  Therefore, the Board concluded that the MEB/orthopedic examination be apportioned exclusive probative value in this case.  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’s adjudication for the neck condition.  

Lumbar Spine Condition.  Absent trauma, the service treatment record (STR) noted sudden onset of LBP beginning in November 2007 which worsened upon exercise, stooping, bending, and lifting.  X-rays did not reveal any acute abnormal bony process.  There was minimal degenerative disc bulging of the lumbar spine.  In early 2008, the CI endorsed numbness in the left leg down to the thigh.  A neurologic work-up was normal.  The condition was listed on the permanent profile. 

At the NARSUM examination, the CI endorsed that his LBP remained worse upon standing, walking and exercising.  He denied radicular pain, paresthesias or weakness of the lower extremities.  His PE revealed a normal gait and completely normal findings specific to the low back and lower extremities.  His diagnosis was listed as ‘mild intervertebral disc degeneration of the lumbosacral spine.’  At the VA C&P examination, the CI’s examination revealed very limited thoracolumbar ROM, but as noted above, the remoteness of this PE remained outside the Boards period of review.  Again, examination probative value is placed on the MEB/orthopedic evaluation a month prior to separation.  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)	PT ~3 Mo. Pre-Sep	MEB/Ortho ~1 Mo. Pre-Sep	
Flexion (90 Normal)	(25) 22,24,26	65 (67)	
Extension (30)	(10) 12,12,12	30	
R Lat Flexion (30)	(25) 26,22,23	30	
L Lat Flexion (30)	(25) 25,24,23	30 (28)	
R Rotation (30)	(30) 40,40,42	30 (40)	
L Rotation (30)	(30) 35,32,30	30 (50)	
Combined (240)	135	215	
Comment	Painful Motion	Painful Motion	
§4.71a Rating	40%	10%	

The Board directed its attention to its rating recommendation based on the above evidence.  Both the PEB and VA coded the low back condition 5237 (lumbosacral strain) and rated 10% and 40% respectively, citing limited motion.  As previously stated the MEB/orthopedic evaluation garners the highest in probative value and clearly supports a 10% rating due to the thoracolumbar flexion of 65 degrees.  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 low back condition.  

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that the left shoulder condition was not unfitting.  Although the left shoulder condition was profiled, it was not judged to fail retention standards.  The condition was reviewed and considered by the Board.  There were few clinical encounter documents with regard to the left shoulder contained in the case file.  The Board members agreed that the few records in evidence indicated that the majority of shoulder pain was intermittent and was reflected of nearby muscle spasms that originated with the CI’s neck condition.  The NARSUM noted full active ROM and 5/5 strength.  There was no performance based evidence from the STR that the left shoulder condition significantly interfered with satisfactory duty performance.  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’s fitness determination for the shoulder condition and so no additional disability rating is recommended.

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.  In the matter of the contended left shoulder condition, the Board unanimously recommends no change from the PEB’s determination 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 20143756, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB

MEMORANDUM FOR Commander

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation
for XXXXXXXXXXXXXXXXXX, AR20160009342 (PD201403756)

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