RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX 	CASE:  PD-2016-00034
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040115

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated National Guard E6, Motor Transportation Operator, medically separated for “chronic low back pain…” and “chronic neck pain…,” each rated at 10%, with a combined disability rating of 20%.  

CI CONTENTION:  “…the injury to my back and neck was more than originally diagnosis by the Military.  There was no weight given for pain…It was not until going to a private Dr. who did MRI’s on each level of my back, did I know the full extent of the injuries received in Iraq.”  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 - 20031028	VARD – 20040922	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain… 	5243 
5299-5237	10%	Traumatic Arthritis, Lumbosacral Spine, with Limitation of Motion	5010-5242	10%	20040823	
Chronic Neck Pain…	5237	10%	Traumatic Arthritis, Cervical Spine, with Limitation of Motion	5010-5242	10%	20040823	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain (LBP).  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s LBP began in 1991 and a left L5-S1 hemi laminectomy/discectomy was performed in 1994.  An injury in 1999 resulted in an L4-L5 disk herniation, which was aggravated after a military vehicle accident while deployed to Iraq in May 2003.  Radiographic studies in July 2003 documented multilevel degenerative changes of the thoracic spine.  Further imaging (MRI) in August 2003 showed evidence of degenerative disc disease (DDD) from L4 to L5, a right paracentral disk bulge at L4-5 without significant nerve root involvement, and mild disk extrusion at L5-S1.  At a 4 August 2003 physical therapy (PT) visit, 5 months prior to separation, range of motion (ROM) measurements showed  flexion to 70 degrees (normal 90) and a combined ROM of 185 degrees (normal 240).  

At the 25 August 2003 MEB NARSUM examination, the CI reported daily lower lumbar pain and intermittent symptoms in the left lower extremity.  Physical examination showed a normal gait, mild tenderness, and normal strength and reflexes.  Testing for radiculopathy was negative.  

At the 23 August 2004 VA Compensation and Pension (C&P) evaluation, 7 months after separation, the CI reported LBP and denied radiation.  Physical examination noted normal lordosis and strength.  ROM measurements showed flexion to 85 degrees and a combined ROM of 235 degrees.  Radiographic evaluation showed DDD and degenerative joint disease (DJD) at the L4-S1 levels.  

The panel directed attention to the rating recommendation based on the above evidence.  The PEB rated the back condition 10%, coded 5243 and 5299-5237 (intervertebral disc syndrome and lumbosacral strain), citing combined range of motion 220 degrees, no muscle spasm, and pain on motion.  The VA also rated the back condition 10%, coded 5010-5242 (degenerative arthritis and degenerative arthritis of the spine), based on the C&P evaluation 7 months after separation, citing limitation of motion.  The panel 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 PT and VA C&P examinations.  There was no muscle spasm or guarding severe enough to result in an abnormal gait or spinal contour, thus the next higher 20% rating was not justified on this basis.  There was no documentation of intervertebral disc syndrome (IVDS) with incapacitating episodes which would provide for a higher rating under that formula for IVDS, or evidence of ratable peripheral nerve impairment which would provide for additional rating.  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 LBP condition.  

Chronic Neck Pain.  According to the STR and MEB NARSUM, the CI’s neck condition began in May 2003 after a military vehicle accident.  Radiographic evaluation in July 2003 documented DDD at the C4-C7 vertebral levels.  At a 4 August 2003 PT visit, ROM measurements showed flexion to 45 degrees (normal) and a combined ROM of 245 degrees (normal 340), with pain elicited by rotation and extension.  On 22 August 2003, PT ROM measurements documented flexion to 25 degrees and a combined ROM of 230 degrees; pain was not addressed.  

The 25 August 2003 MEB NARSUM examination, 4 months prior to separation, noted CI complaints of persistent pain with extension and rotation, and no left upper extremity symptoms.  Physical examination showed normal strength, reflexes, and sensation bilaterally.  At an October 2003 PT visit, 3 months before separation, ROM was described as “symmetric active ROM” that was “only limited in extension.”  

At the 23 August 2004 VA Compensation and Pension (C&P) evaluation, 7 months after separation, the CI reported neck stiffness and denied any negative impact to his current job.  Physical examination showed midline tenderness over C5-C7 and normal curvature.  ROM measurements showed flexion to 45 degrees, extension to 40 degrees (normal 45); left and right lateral flexion to 25 degrees and 30 degrees, respectively (normal 45), and left and right lateral rotation to 50 degrees each (normal 80) with a combined ROM of 240 degrees.  Radiographic evaluation documented DDD and DJD at the C5-C7 levels with narrowing of the nerve canal on the left.  

The panel directed attention to the rating recommendation based on the above evidence.  The PEB rated the neck condition 10%, coded 5237 code (cervical spine strain), citing combined range of motion 230 degrees.  The VA also assigned a 10%, coded 5010-5242 code (arthritis, degenerative-degenerative arthritis of the spine), citing limitation of motion.  While the 22 August 2003 PT examination recorded cervical flexion to 25 degrees that would support a 20% rating, the panel agreed that the 4 August 2003 and October 2003 PT evaluations, as well as the August 2004 VA C&P examination all consistently recorded ROM measurements meeting criteria for a 10% rating.  There was no muscle spasm or guarding severe enough to result in an abnormal spinal contour, thus the next higher 20% rating was not justified.  There was no documentation of intervertebral disc syndrome with incapacitating episodes which would provide for a higher rating under that formula, or evidence of ratable peripheral nerve impairment which would provide for additional rating.  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.

BOARD FINDINGS:  In the matter of the chronic low back pain condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the chronic neck pain condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  There are no other conditions within the panel’s scope of review for consideration.  The panel, therefore, recommends there be no modification or re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20151030, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170015123, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

 Dear XXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	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.

Sincerely,					      
						      					
Enclosure