RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00200
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090901

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a National Guard E3, Information Technology Specialist, medically separated for “chronic neck pain” and “chronic right hip pain” as unfitting, rated 20% and 0% respectively, with a combined disability rating of 20%.  

CI CONTENTION:  The CI lists several conditions for contention: lower back pain, hip and groin pain, kidney infection, and an injury to the sacrum.  The complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The panel’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 panel’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 panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The panel’s assessment of the PEB rating determinations is based on 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 panel 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 panel 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 - 20090721	VARD - 20100526	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Neck Pain	5299-5237	20%	Spondylosis, Cervical Spine	5237	20%	20100513	
Chronic Right Hip Pain	5299-5255	0%	Status Post Stress Fracture, Right Femur with Residual Right Hip Strain	5252	10%		
Low Back Pain	Not Unfitting	Low Back Condition to include Pain	5237	NSC	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Chronic Neck Pain.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s chronic neck pain condition began in December 2008 after keeping a rifle over her head for an extended period and feeling her left hand going numb.  

During the 3 June 2009 MEB examination (recorded on DD Forms 2807-1 and 2808), 3 months prior to separation, the CI reported pain in the shoulder on the left side with arm and hand numbness/tingling.  The physical examination showed chronic left neck pain.  

The 26 June 2009 MEB NARSUM examination, 3 months prior to separation, noted complaints of pain and stiffness in the left side of the neck that went into the trapezius with occasional numbness in the left hand.  There was also increased pain with upper body exercise.  The physical examination showed decreased range of motion (ROM) secondary to pain only, no atrophy or involuntary muscle contractions with normal spinal contour and strength.  Her forward flexion was 25 degrees (normal 45).   

At the 13 May 2010 VA Compensation and Pension (C&P) evaluation, 8 months after separation, the CI reported constant moderate pain in her neck that traveled to her arm and was made worse with activity such as typing on a computer.  It was relieved by rest.  The physical examination of the cervical spine revealed no ankylosis and no tenderness.  There was no evidence of weakness or radiating pain on movement and no guarding or loss of tone or atrophy of the limbs.  There was evidence of muscle spasm described as cervical muscles.  Her cervical forward flexion was 30 degrees (normal 45).  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic neck condition 20%, coded 5299-5237 (analogous to lumbosacral or cervical strain), citing limitation of motion.  The VA also rated the spondylosis, cervical spine (claimed as disc osteophyte complex, left side of neck to include pain) condition 20%, coded 5237 (lumbosacral or cervical strain), based on the C&P examination 8 months after separation, citing limitation of forward flexion.  

The panel agreed that a 20% rating, but no higher, was justified for a forward flexion of the cervical spine greater than 15 degrees but not greater than 30 degrees as reported on both the NARSUM and C&P examinations proximate to separation.  The panel also considered if additional disability rating was justified for peripheral nerve impairment due to radiculopathy.  The CI reported left hand numbness but MRI studies did not support this other than C-5/6 neural foraminal narrowing that could result in some level of radicular nerve irritation or involvement. However, the physical examinations (MEB NARSUM and VA C&P) proximate to separation revealed no objective findings of radiculopathy that would impact duty performance.  The presence of functional impairment with a direct impact on fitness is the key determinant in the panel’s decision to recommend any condition for rating as additionally unfitting.  While the CI may have suffered additional pain from the nerve involvement, this is subsumed under the general spine rating criteria, which specifically states “with or without symptoms such as pain (whether or not it radiates).”  Therefore, the critical decision is whether or not there was a significant neurologic impairment which would impact military occupation-specific activities.  There was no evidence in this case that a neurologic abnormality existed to any degree that could be described as functionally impairing.  The panel 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 panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the chronic neck pain condition.  

Chronic Right Hip Pain.  According to the STR and the MEB NARSUM, the CI’s chronic right hip pain condition began in December 2008 after exertion during exercises in basic training.  At a 21 May 2009 physical therapy evaluation, 3 months prior to separation, the CI reported being mostly pain-free with an occasional ache in the groin area when jogging.  The physical examination showed full ROM compared to left unaffected side.  Right hip flexion was 100 degrees (normal 125), abduction 40 degrees (45 normal), internal and external rotation full, but she had discomfort on the extremes of ROM.  

During the June 2009 MEB examination (recorded on DD Forms 2807-1 and 2808), 3 months prior to separation, the CI reported pain on the right side when standing for a length of time.  The physical examination showed a slight decrease in right hip ROM with a diagnosis of right femoral stress fracture.  

The 26 June 2009 MEB NARSUM examination, 3 months prior to separation, noted complaints of continued increased pain with prolonged walking.  The physical examination showed decreased ROM secondary to pain only, and no atrophy or involuntary muscle contractions.  She had the ability to cross her legs bilaterally and had 5/5 strength in both lower extremities.  The CI’s forward flexion was 55 degrees (normal 125), extension 5 degrees (normal 10), and abduction 20 degrees (normal 45).  

At the 13 May 2010 VA Compensation and Pension (C&P) evaluation, 8 months after separation, the CI reported sharp, sticking pain in the right hip occurring five times per week; each lasting for 1 hour, with a pain level of 3/10.  The pain was exacerbated by physical activity, standing for prolonged periods of time and walking up stairs.  It was relieved by rest and Tylenol.  At the time of pain, she could function with medication.  There were also additional symptoms of difficulty walking.  The physical examination showed normal posture, tenderness and guarding of movement on the right side, and no subluxation or ankylosis.  Right hip ROM in degrees was flexion 92, extension 23, abduction 45, internal rotation 21 (normal 40), and external rotation 32 (normal 60). 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic right hip pain condition 0%, coded 5299-5255 (analogous to femur, impairment of), citing stress fracture of the right hip.  The VA  rated the status post stress fracture, right femur with residual right hip strain condition 10%, coded 5255 (thigh, limitation of, flexion), based on the C&P examination 8 months after separation, citing painful and limited ROM.  

The panel looked at the totality of the examinations and placed greater probative value on the VA examination which was more thorough.  There was no hip ankylosis that supported a rating under the VASRD diagnostic code 5250.  There was no limitation of flexion or extension that supported a rating under the VASRD diagnostic codes for limitation of motion (5251 or 5252). There was no limitation of abduction, adduction or rotation that supported a rating under the VASRD diagnostic code for limitation of motion (5253).  There was no hip flail joint that supported a rating under the VASRD diagnostic code (5254).  However, there was evidence of painful motion of the left hip with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the chronic right hip pain condition, analogously coded 5299-5252 (thigh, limitation of flexion).  

Contended PEB Condition:  Low Back Pain.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The contended condition was not profiled, implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the chronic neck pain condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the chronic right hip pain condition, the panel unanimously recommends a disability rating of 10%, analogously coded 5299-5252 IAW VASRD §4.71a.  In the matter of the contended low back pain condition, the panel unanimously agrees that it cannot recommend it for additional disability rating.  There are no other conditions within the panel’s scope of review for consideration.  The panel recommends that the CI’s prior determination be modified as follows; and, that the discharge with severance pay be re-characterized to reflect permanent disability retirement, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Neck Pain	5299-5237	20%	
Chronic Right Hip Pain	5299-5252	10%	
COMBINED	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150310, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170005963, XXXXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXXXX:

	I accept the recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) to re-characterize your separation as a disability retirement with the combined disability rating of 30% effective the date of your medical separation for disability with severance pay.  Enclosed is a copy of the Board’s recommendation and record of proceedings for your information.

	The re-characterization of your separation as a disability retirement will result in an adjustment to your pay providing retirement pay from the date of your original medical separation minus the amount of severance pay you were previously paid at separation.
 
	The accepted DoD PDBR recommendation has been forwarded to the Army Physical Disability Agency for required correction of records and then to the U.S. Defense Finance and Accounting Service to make the necessary adjustment to your pay and allowances.  These agencies will provide you with official notification by mail as soon as the directed corrections have been made and will provide information on your retirement benefits.  Due to the large number of cases in process, please be advised that it may be several months before you receive notification that the corrections are completed and pay adjusted.  Inquiry concerning your correction of records should be addressed to the XXXXXXXXXXXXXXXXXXXXX.

	A copy of this decision has also been provided to the Department of Veterans Affairs.

Sincerely,					      
Enclosure