RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX 	CASE:  PD-2016-01731
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040915

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a Reserve E5, Ammunition Specialist, medically separated  for “chronic neck pain, ” “chronic low back pain” and “chronic groin pain,” rated 10%, 10% and 0%, respectively, with a combined disability rating of 20%.  

CI CONTENTION:  “Rating was lower than it should have been.”  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 Medical Evaluation Board (MEB), but determined by the PEB 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.  The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence relevant to application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards for 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, which operates 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 disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20040803	VARD - 20050504	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Neck Pain, without Neurologic Abnormality	5299-5237	10%	Cervical Strain	5237	10%	20041210	
Chronic Low Back Pain, without Neurologic Abnormality	5299-5237	10%	Lumbosacral Strain	5237	10%	20041210	
Chronic Groin Pain	8799-8730	0%	Status Post Right Inguinal Herniorraphy	7338-7805	0%	20041210	
			Chronic Groin Strain, Right	8799-8730	0%	20041210	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Chronic Neck Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s neck condition began in March 2003 when deployment training intensity accelerated.  On 4 March 2004, X-rays demonstrated mild straightening of the cervical spine, hypertrophy of the uncinate process at C5-6 and C6-7, and thick cervical ribs (an extra rib which is a congenital abnormality) at C7 bilaterally.  Subsequent X-rays on 19 March 2004 demonstrated no encroachment upon the neural foramina from the uncinate process hypertrophy.  

At the 26 April 2004 primary care visit, the CI reported grinding neck pain rated at 2-3/10.  Physical examination showed range of motion (ROM) measurements, in degrees, of: cervical flexion to 45 (normal), extension to 30 (normal 45), lateral bending to 40 (normal 45), and rotation to 60 (normal 80), with a combined ROM of 275 degrees.

The 17 May 2004 MEB ROM measurements, in degrees, were: cervical flexion to 20, extension to 30 (with tingling into the right hand), left lateral flexion to 20, right lateral flexion to 30, left rotation to 30, and right rotation to 25 (with pain in the right trapezius during cervical rotation); combined ROM was 155.  During the 21 May 2004 MEB NARSUM examination, 4 months prior to separation, the CI complained of neck pain, which increased with motion, but denied pain radiation to the upper extremities.  Physical examination showed paraspinal tenderness with increased muscle tone.  

At the 10 December 2004 VA Compensation and Pension (C&P) examination, 3 months after separation, the CI reported sharp, cervical neck pain rate at 7/10, but denied incapacitating episodes; narcotic medication relieved his pain. Physical examination showed no evidence of tenderness or muscle spasm, but there was evidence of painful motion with flexion and extension.  The ROM measurements, in degrees, were:  cervical flexion to 40, extension to 35, left and right lateral flexion to 45, and left and right rotation to 80, with a combined ROM was 325.  Additional limitation was primarily due to pain.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the neck condition 10%, analogously coded 5299-5237 (cervical strain), citing cervical ROM limited by pain, with localized tenderness.  The VA also rated the neck condition 10%, coded 5237, based on the C&P examination, citing forward flexion greater than 30 degrees, but not greater than 40 degrees.  Members noted the discrepancy between the MEB and VA cervical flexion measurements as well as the increased cervical muscle tone at the time of the MEB examination versus no evidence of tenderness or muscle spasm at the VA examination.  The panel agreed that while other STR measurements and the VA examination represented the CI’s normal functional ROM, the MEB findings represented an exacerbation.  Members therefore placed higher probative value on the VA examination, and adjudged that a 10% rating, but no higher, was justified for limitation of flexion greater than 30 degrees but not greater than 40 degrees, as reported on the primary care and VA examinations.  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 on this basis.  After due deliberation, considering all 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.  

Chronic Low Back Pain (LBP).  According to the STR and MEB NARSUM, the CI’s LBP began in April 2003 with no specific trauma.  On 22 July 2003, an orthopedic evaluation documented MRI results indicating a small, broad-based disc bulge at L4 with flattening of the anterior thecal sac, but no evidence of canal stenosis.  At the primary care visit on 26 April 2004, the CI reported chronic LBP, and the physical examination noted thoracic tenderness and lumbar muscle spasms bilaterally.  The provider recorded pain at 80 degrees during flexion, but noted that the CI was able to sit on the examination table with legs fully extended to remove his socks.  

The MEB ROM measurements, in degrees, revealed forward flexion to 70 (normal 90), extension to 5 (normal 30), left and right lateral flexion to 20 (normal 30), left rotation to 25 (normal 30), and right rotation to 35 (normal 30); combined ROM was 170 (normal 240).  Extension and rotation motions were painful.  The MEB NARSUM examination noted CI complaints of lower back stiffness and burning which radiated to the back of both legs.  Physical examination showed mild lumbar paraspinal tenderness as well as increased back pain and burning in the back of the legs with straight leg testing.  The examiner noted that avoidance behavior (indicative of pain) was not observed.  

At the C&P examination, the CI reported LBP rated at 7/10, and incapacitating episodes as often as once a month which lasted for 3 days.  Physical examination did not demonstrate tenderness or muscle spasm, and ROM measurements showed forward flexion to 50 degrees and extension to 15 degrees, with normal ranges in all other planes and a combined ROM of 185 degrees.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back condition 10%, analogously coded 5299-5237 (lumbosacral strain), citing thoracolumbar ROM limited by pain with localized tenderness, and AR 635-40, paragraph B-24f, which “restricts the maximum rating for pain--regardless of how many separate anatomical sites to 20%.”  The VA also rated the back condition 10%, coded 5237, based on the C&P examination, citing the 10% rating criteria for diseases and injuries of the spine.  Members agreed that a 10% rating, but no higher, was justified for limitation of flexion greater than 60 degrees but not greater than 85 degrees, as reported on the MEB NARSUM examination and combined ROM greater than 120 degrees but not greater than 235 degrees as reported on both the MEB and VA 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.  After due deliberation, considering all 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 low back condition.  

Chronic Groin Pain.  According to the STR and MEB NARSUM, the CI’s groin pain began in January 2003 with swelling in the left testicle (which resolved with treatment), and subsequent swelling in the right testicle.  The MEB NARSUM examiner noted complaints of pain in the right testicle and at base of the penis, and that the CI underwent an inguinal hernia repair in July 2002 and removal of a lipoma from the right spermatic cord in December 2003.  Physical examination showed tenderness of the right testicle and at the base of penis.  At the C&P examination, the CI reported chronic groin pain; testicular and abdominal examinations were normal.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the groin pain condition 0%, analogously coded 8799-8730 (ilio-inguinal nerve neuralgia), citing moderate paralysis.  The VA also rated the groin pain condition 0%, analogously coded 8799-8730, based on the C&P examination, citing incomplete paralysis of the ilio-inguinal nerve which is mild or moderate.  The panel noted that the highest rating for neuralgia is a maximum equal to moderate incomplete paralysis or 0% IAW §4.124.  After due deliberation, considering all 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 groin condition.  

BOARD FINDINGS:  In the matter of the chronic neck pain and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the chronic low back pain and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the groin pain and IAW VASRD §4.124a, the panel recommends no change in the PEB adjudication.  There are no other conditions within the panel’s scope of review for consideration.  Therefore, the panel recommends 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 20161107, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record  

AR20180013027, 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