RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00661
BRANCH OF SERVICE:  army 	SEPARATION DATE:  20040130

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Traffic Management Coordinator, medically separated for “chronic low back pain” and “chronic cervical neck pain,” each rated 10%, with a combined disability rating of 20%.   

CI CONTENTION:  His back condition worsened and caused him to have chronic neck pain with occasional symptoms of thoracic outlet syndrome.  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 - 20041209	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Mechanical Low Back Pain	5299-5237	10%	Chronic Lumbar Spine Strain	5237	20%	20020909	
Chronic Cervical Neck Pain	5299-5237	10%	Cervical Spine Strain	5237	10%	20020909	
COMBINED RATING: 20%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:  

Chronic Mechanical Low Back Pain (LBP).  According to the service treatment record (STR) and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s chronic mechanical LBP condition began insidiously in 1996.  A 21 February 1999 lumbar spine MRI noted mild degenerative disc disease without nerve root impingement.  The 18 September 2003 MEB NARSUM examination, 4 months prior to separation, noted complaints of LBP radiating down the back of both legs to the toes.  Physical examination showed the CI could forward flex to within 6 inches of touching the floor with the knees in the extended position; he could side-bend (laterally flex) down to about the level of his fibular heads bilaterally.  Palpation of the spine elicited pain in the right paravertebral muscles.  Testing to detect radicular signs was negative bilaterally.  

At the 9 September 2004 VA Compensation and Pension (C&P) evaluation, 8 months after separation, the CI reported pain and discomfort primarily centered in the right lumbar area of his spine.  The CI stated that flare-ups occurred with excessive lifting and carrying of more than moderate to moderately heavy weights, as well as excessive crouching and squatting.  He denied incapacitating episodes.  Physical examination showed tenderness of the L4-L5 spine without muscle spasms.  Range of motion (ROM) testing showed flexion of 80 degrees (normal 90) after repetition with pain and combined ROM of 180 degrees (normal 240) with pain on extension and lateral flexion.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, coded 5299-5237 (analogous to lumbosacral strain).  The VA rated the back condition 20%, coded 5237, based on the C&P examination 8 months after separation, citing evidence of pain and reduction in motion with repetition.

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/or combined ROM (greater than 120 degrees but not greater than 235 degrees), as reported on the VA examination, which was the only examination with goniometric measurements.  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.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the LBP condition.

Chronic Cervical Neck Pain.  According to the STR and MEB NARSUM, the CI’s neck condition began insidiously in 1996.  MRI was essentially normal.  The 18 September 2003 MEB NARSUM examination noted complaints of worsening neck pain with bilateral upper extremity numbness and left wrist pain. The CI reported increased pain with axial compression of his cervical spine which reproduced pain in his rhomboid and trapezius area, more so on the right than on the left.  Physical examination showed he could forward flex so that his chin touched his chest and could extend his neck and look at the ceiling without any apparent restrictions.  Side-bending (lateral flexion) in the cervical spine was symmetric at about 60 degrees (normal 45) bilaterally.  Rotation was symmetric at about 75 degrees (normal 80) bilaterally.  He reported pain on palpation in the right paravertebral muscles.  The pain extended down from the para-cervical muscles to about the rhomboids on the right side, and on the left side he also had some paravertebral muscle discomfort. The examiner referenced an electromyogram which was consistent with thoracic outlet syndrome (neck region compression of the nerves and blood vessels that go to the arm) and no evidence of cervical radiculopathy.  

At the 9 September 2004 C&P evaluation the physical examination showed cervical flexion to 40 degrees (normal 45) with pain.  Combined cervical ROM was 245 degrees (normal 340) after repetition.  Painful motion was noted with rotation movements.  There was no weakness, incoordination or fatigability noted with repetitive movements.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the neck condition 10%, coded 5299-5237 (cervical strain), citing “occasional symptoms of thoracic outlet syndrome.”  The VA rated the neck condition 10%, coded 5237, (cervical strain) based on the C&P examination 8 months after separation, citing forward flexion of the cervical spine greater than 30 degrees but not greater than 40 degrees and limited by pain.  There was no evidence of muscle spasm or guarding severe enough to result in an abnormal spinal contour for a 20% rating.  The panel also considered a rating for thoracic outlet syndrome as mild neuralgia of the upper radicular group for a 20% rating; however, there was no evidence of upper extremity weakness, fatigability, incoordination, or sensory deficit to support this rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the neck condition.

BOARD FINDINGS:  In the matter of the back condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the neck condition and IAW VASRD §4.124a, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the contended thoracic outlet syndrome, 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, 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 20160915, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170016912, XXXXXXXXXXXXXXXXXXX 

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

	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