RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01828
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060301

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a National Guard E4, Infantryman, medically separated for “chronic neck pain” and “chronic low back pain,” rated 0% each, with a combined  disability rating of 0%.  

CI CONTENTION:  The CI requested review of multiple conditions.  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 review of disability ratings assigned 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 or non-compensable.  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 determination 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(s) 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 - 20060112	VARD - 20060616	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Neck Pain	5237	0%	Cervical Spine Strain with Muscle Spasms	5237	0%	20060419	
Chronic Low Back Pain		0%	Lumbar Spine L1 Compression Fracture	5243	0%		
Adjustment Disorder with Depressed Mood - Resolved	Not Unfitting	No VA Examination in Evidence	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

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 August 2004 when riding in the back of a 5-ton truck on a rough road in Afghanistan.  The truck hit a pothole and threw the CI in the air.  He landed very forcefully back in his seat (while wearing his gear to include helmet and body armor).  He had immediate severe non-radicular back pain and radicular neck pain in that his left arm and little / ring fingers went numb.  The numbness resolved after about 10 minutes. He continued to have shooting pains from his neck down his left arm for about 2 days, by which time all of his symptoms had resolved. Radiographic evaluation requested in December 2004 demonstrated mild movement of the C5 over the C6 vertebrates and narrowing of the disk space (degenerative disc disease.  A magnetic resonance imaging study performed on 22 February 2005 also showed degenerative disk disease throughout the cervical most focal at the C5-6 level.  The CI underwent physical therapy, steroid injection, and pain medication with improvement sufficient to perform the duties of his MOS.  

At a physical therapy session evaluation dated 26 August 2005 the CI reported 002/10 pain with light daily activities and increased 5-6/10 pain with running.  The range of motion (ROM) of the cervical spine was normal except for 5 degree decreased right and left lateral flexion; a combined ROM of 330 degrees (normal 340).  The therapist noted that the CI’s primary deficits were related to strength and endurance.  

The 1 September 2005 MEB NARSUM examination, 6 months prior to separation, noted complaints of neck pain with certain movements.  The examiner referenced focused physical examinations by orthopedic surgery and physical therapy.  

At the 19 April 2006 VA Compensation and Pension (C&P) evaluation, 2 months after separation, the CI did not report neck pain.  The physical examination showed full painful cervical ROM, moderate paraspinal muscle spasm and moderate straightening of the normal curvature.  The examiner referenced cervical spine x-rays which demonstrated straightening of the normal curve, likely due to muscle spasms.  

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the chronic neck condition 0%, coded 5237(cervical strain), citing flexion greater than 40 degrees.  The VA also rated the chronic neck condition 0% coded 5237 (cervical strain), based on the C&P examination citing forward flexion of the cervical spine greater than 40 degrees; or, combined range of motion of the cervical spine greater than 335 degrees.  The panel noted that the cervical spine cervical ROM documented by physical therapy met criteria for a 10% rating for a combined ROM not greater than 335 degrees.  The VA examination demonstrated muscle spasms severe enough to result in an abnormal spinal contour for a 20% rating; however, the panel noted that the examination coincided with an acute exacerbation of back pain.  There was no evidence of intervertebral disc syndrome (IVDS) which resulted in incapacitating episodes requiring physician-prescribed bed rest to warrant consideration of rating under the alternate VASRD formula for that condition.  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 neck pain condition, coded 5237.  

Chronic Low Back Pain.  According STR and the MEB NARSUM, the CI’s chronic low back pain condition originated from the same incident cited above occurring in Afghanistan in August 2004. A magnetic resonance imaging study performed on 22 February 2005 showed degenerative disk disease at two lumbar levels (L4-5, L5-6).  

At a physical therapy session evaluation dated 26 August 2005 the therapist documents a combined ROM between 180-225 degrees (normal 240).  At a physical therapy session evaluation dated 6 October 2005 the therapist documented lumbar flexion to 65 degrees (normal 90) and lateral flexion to 25 degrees (normal 30).  

The MEB NARSUM examination noted complaints of persistent lower back pain.  The examiner referenced focused physical examinations by orthopedic surgery and physical therapy.  

At the C&P evaluation the CI reported that his lower back pain had improved until a couple of weeks prior to his examination.  He also reported that the pain worsens with weather changes.  The physical examination showed mild flattening of the lumbar curve, moderate spasm of the paraspinal muscles with painful, full ROM.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic low back pain condition 0%, coded 5237 (lumbosacral strain), citing normal range of motion of the lower back.  The VA also rated the chronic low back pain condition 0% coded 5243 (intervertebral disc syndrome), based on the C&P examination citing vertebral body fracture with loss of less than 50 percent of the height.  The panel noted that the physical therapy ROM of 225 degrees met criteria for a 10% rating for combined thoracolumbar ROM noted greater than 235 degrees and the VA examination met criteria for a 10% rating for painful motion IAW VASRD §4.59 .  The VA examination demonstrated muscle spasms severe enough to result in an abnormal spinal contour for a 20% rating; however, the panel noted that the examination coincided with an acute exacerbation of back pain.  There was no evidence of intervertebral disc syndrome (IVDS) which resulted in incapacitating episodes requiring physician-prescribed bed rest to warrant consideration of rating under the alternate VASRD formula for that condition.  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 low back pain condition, coded 5237.  

Contended PEB Conditions:  Adjustment Disorder with Depressed Mood - Resolved.  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 or 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, the panel unanimously recommends a disability rating of 10%, coded 5237 IAW VASRD §4.71a.  In the matter of the chronic low back pain condition, the panel unanimously recommends a disability rating of 10%, coded 5237 IAW VASRD §4.71a.  In the matter of the contended adjustment disorder with depressed mood condition, the panel unanimously recommends no change from the PEB determination as not unfitting.  There were 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, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Neck Pain	5237	10%	
Chronic Low Back Pain	5237	10%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150702, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170009272 , XXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction. 

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

Sincerely,	
Enclosure