RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00266
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20070421

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Unit Supply Specialist, medically separated for chronic lower back and neck pain conditions, rated 0% and 0%, respectively, with a combined  disability rating of 0%.

CI CONTENTION:  No specific contention made.  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 - 20070305	VARD - 20070726	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Neck Pain	5299-5237	0%	Neck and Back Pain	5237	NSC	20070419	
Chronic Lower Back Pain 	5299-5237	0%					
Idiopathic Scoliosis	Not Unfitting					
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  NSC	

ANALYSIS SUMMARY:

Chronic Neck Pain.  According to service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s cervical spine condition began in 2002 during basic training when the CI wore a ruck sack and did road marches which developed into lower back pain (LBP) and later spread to her upper back.  Cervical spine X-rays performed in August 2006 demonstrated mild straightening of the normal cervical curvature with no evidence of fracture or osseous defect, but signs of degenerative changes.

The 8 August 2006 MEB NARSUM examination, 8 months before separation, noted complaints of intermittent neck pain with flexion.  Pain did not radiate to her arms.  Physical examination revealed a normal gait and no cervical spine tenderness.  Repetitive range of motion (ROM) was flexion to 35 degrees (normal 45) and combined ROM was 270 degrees (normal 340) with painful motion.  At a chiropractic examination on 18 December 2006 the cervical spine showed no abnormalities and chiropractic manipulative treatment was performed.

During the 19 April 2007 VA Compensation and Pension (C&P) evaluation, less than 1 month before separation, the CI reported recurrent neck pain without radiation which was not incapacitating.  Physical examination showed a normal gait and no cervical spine tenderness.  ROM was flexion to 30 degrees and the combined ROM was 150 to 170 degrees.  There was no pain with repetitive motion.  X-rays of the cervical spine on 19 April 2007 were essentially normal.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the cervical spine condition 0%, analogously coded 5299-5237 (cervical strain), citing a condition that existed prior to service (EPTS) and was permanently service aggravated (PSA).  The VA did not service connect the cervical condition, also coded 5237, based on the C&P examination less than a month before separation, citing an EPTS condition without PSA evidence.

The panel agreed that a 20% rating, but no higher, was justified for limitation of flexion (greater than 15 degrees but not greater than 30 degrees) and/or combined ROM not greater than 170 degrees as reported on the VA examination.  There was scant STR or VA ROM evidence.  The panel agreed the VA examination less than a month before separation supported the highest probative value, despite the absence of any injury or accident documentation.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 20% for the chronic neck pain condition, coded 5237.

LBP.  According to the STR and MEB NARSUM, the CI first became aware of her spine curvature during the military entrance physical examination in 2002, but her LBP symptoms did not begin until basic training when the she CI wore a ruck sack and did road marches.  There was no surgical indication.  Radiographic studies on 3 March 2004 demonstrated dextroscoliosis (curvature to the right) of the thoracic spine measuring 16 degrees, with no evidence of congenital anomaly.  Chiropractic treatment for scoliosis in July 2005 provided no improvement.  A lumbar spine X-ray performed the same day showed left lumbar curve, but was otherwise normal.

The 8 August 2006 MEB NARSUM examination, 8 months prior to separation, noted complaints of intermittent stabbing pain located in the mid back that sometimes went into both upper thighs but did not radiate to her arms.  Physical examination showed a normal gait, reflexes, and strength; there was no paraspinal muscle spasm, and maneuvers for radicular signs were negative.  There was right thoracic scoliosis.  Thoracolumbar ROM was flexion to 75 degrees (normal 90) and combined ROM was 225 degrees (normal 240) which was limited by pain.  During the 18 September 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 7 months prior to separation, the CI reported back pain.  Physical examination showed thoracic and lumbar spine tenderness with right thoracic scoliosis and “decreased ROM” of the lower back.

At the 19 April 2007 C&P evaluation, less than a month before separation, the CI reported recurrent neck and LBP without incapacitating pain or pain radiation.  Physical examination showed a normal gait without spinal tenderness, postural abnormalities, or painful motion.  Thoracolumbar ROM was flexion to 90 degrees and combined ROM was 210 degrees without pain, weakness, fatigability, decreased endurance, or incoordination noted.  There was no pain with repetitive motion.  Thoracic spine X-rays demonstrated some rotatory scoliosis.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the LBP condition 0%, analogously coded 5299-5237 (lumbosacral strain), citing the condition as EPTS and PSA.  The VA did not service connect the LBP condition, also coded 5237, based on the C&P examination less than 1 month before separation, citing a condition that was EPT without evidence of PSA.

The panel agreed 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) as reported on the MEB NARSUM examination.  The panel agreed the MEB NARSUM was a more thorough examination and represented the preponderance of STR evidence.  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 evidence of intervertebral disc syndrome resulting in incapacitating episodes requiring physician-prescribed bed rest to warrant consideration of rating under that alternate VASRD formula.  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 LBP condition, coded 5237.

Contended PEB Condition:  Idiopathic Scoliosis.  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 nor judged to fail retention standards.  Scoliosis was a component of the overall LBP condition and not an independent condition which could be separately rated IAW §4.14 (avoidance of pyramiding).  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 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 20%, coded 5237 IAW VASRD §4.71a.  In the matter of the chronic LBP condition, the panel unanimously recommends a disability rating of 10%, coded 5237 IAW VASRD §4.71a.  There are no other conditions within the panel’s scope of review for consideration.  The panel recommends 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	20%	
Chronic LBP	5237	10%	
COMBINED	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160502, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170015237, XXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

	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 U.S. Army Physical Disability Agency, (AHRC-DO), XXXXXXXXXXXXXXXXXXX.

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

Sincerely,					      
Enclosure