RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX 	CASE:  PD-2017-00571
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20070219

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Infantryman, medically separated for “chronic neck pain,” “low back pain” and “osteoarthritis, right shoulder,” rated 10%, 10% and 0%, respectively, with a combined disability rating of 20%. 

CI CONTENTION:  “Constant pain throughout the day and its every day.  Effects my everyday work and activity.”  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 – 20070103	VARD - 20070905	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Neck Pain	5299-5237	10%	Cervical Strain	5237	20%	20070828	
Low Back Pain	5299-5237	10%	Lumbar Strain	5237	10%	20070828	
Osteoarthritis, Right Shoulder	5003	0%	Right Shoulder Strain	5201	0%	20070828	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Chronic Neck Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s neck condition began in June 2006 after a motor vehicle accident (MVA).  X-rays on 10 July 2006 were normal as was a cervical spine MRI on 8 September 2006.  The 29 September 2006 orthopedic examination, 5 months prior to separation, revealed neck tenderness, no muscle spasm, and normal, pain-free cervical spine range of motion (ROM). 
The 6 November 2006 physical therapy (PT) ROM study, 4 months before separation, showed flexion of 35 degrees (normal 45) and combined ROM of 210 degrees (normal 340).  At the 7 December 2006 MEB NARSUM examination, 2 months prior to separation, the CI complained of constant neck pain aggravated by exertion.  The physical examination (PE) revealed neck tenderness and the examiner referred to the PT ROM measurements.  

At the 28 August 2007 VA Compensation and Pension (C&P) evaluation, 6 months after separation, the CI reported constant neck pain with numbness to his fingertips.  The PE showed resistance to movement of his neck with marked muscle spasm.  Neck ROM was flexion of 30 degrees with a combined ROM of 200 degrees; painful motion was present.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the cervical spine condition 10%, analogously coded 5299-5237 (cervical spine strain), citing ROM limited by pain with localized tenderness.  The VA rated the cervical spine condition 20%, coded 5237, based upon the C&P evaluation, citing reduced flexion.  Members extensively reviewed the STR and agreed that the three pre-separation examinations (ortho, PT, and NARSUM) which were more proximate to separation than the C&P evaluation, best reflected the CI’s cervical spine disability at separation.  Members noted a continued worsening of the neck ROM with normal measurements noted at the initial orthopedic examination 5 months before separation.  The panel did not discover any additional trauma or abnormal pathological processes to explain the decreasing ROM measurements, and agreed that findings of tenderness on the pre-separation examinations as well as reduced and painful motion warranted no higher than a 10% rating.  There was no documentation of intervertebral disc syndrome (IVDS) with incapacitating episodes which would provide for a higher rating under that formula.  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 cervical spine condition. 

Low Back Pain (LBP).  According to the STR and MEB NARSUM, the CI’s back condition began after the above mentioned MVA on 19 June 2006.  X-rays of the lumbar and thoracic spine on 10 July 2006 were normal.  The 29 September 2006 orthopedic examination, 5 months before separation revealed tenderness, no spinal muscle spasm, and normal thoracolumbar spine ROM.  A lumbar spine MRI on 4 October was normal.  

The 6 November 2006 PT ROM study, 4 months prior to separation, showed flexion of 35 degrees (normal 90) and combined thoracolumbar ROM of 155 degrees (normal 240).  At the 7 December 2006 MEB NARSUM examination, 2 months prior to separation, the CI endorsed constant LBP which was worsened upon exertion.  The PE noted lumbosacral spine tenderness and the provider referred to the PT ROM measurements.  

At the 28 August 2007 VA C&P evaluation, 6 months after separation, the CI reported constant LBP varying between 3-6/10 in severity, with pain radiating down the left leg to the foot; he denied incapacitating episodes.  The PE revealed normal gait, reflexes, sensory, motor, and coordination of the lower extremities.  Thoracolumbar ROM showed normal forward flexion and a combined ROM of 180 degrees.  There was no additional limitation of motion after repetition. 
 
The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the LBP condition 10%, analogously coded 5299-5237 (lumbar spine strain), citing thoracolumbar ROM limited by pain with localized tenderness.  The VA also rated the lumbar condition 10%, coded 5237, based on C&P evaluation, citing reduced, combined ROM.  Members could not find any additional trauma or abnormal pathological processes to explain the severe decrease in ROM values reflected in the PT study for the CI’s low back condition.  ROM was normal at the initial orthopedic examination with a return to near normal in the VA post-separation evaluation.  Without clear evidence for the fluctuations, the panel placed a much higher degree of probative value on the orthopedic examination, 5 months before separation, and agreed that the presence of tenderness supported a 10% rating.  There was no documentation of IVDS with incapacitating episodes which would provide for a higher rating under that formula.  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.  
    		
Right Shoulder Osteoarthritis.  According to the STR and MEB NARSUM, the CI’s (dominant) right shoulder condition began in June 2006 after the MVA; right shoulder X-rays on 10 July 2006 were normal.  The 29 September 2006 orthopedic appointment revealed normal, but painful right shoulder ROM, and an MRI on 4 October 2006 showed an abnormal appearing acromial clavicular (AC) joint with a very subtle deformity potentially due to an AC joint separation.  

On 6 November 2006, right shoulder PT ROM measurements were flexion of 90 degrees (normal 180) and abduction of 85 degrees (normal 180), with painful motion.  Repetitive motion was not documented.  The 7 December 2006 MEB NARSUM examination, 2 months prior to separation, noted CI complaints of constant, daily right shoulder pain.  The PE noted painful motion during ROM and strength testing, and referred to PT ROMs.  The examiner noted that based on the mild AC separation MRI findings, surgery would not likely not improve the shoulder condition.  

At the 28 August 2007 C&P evaluation the CI reported a “cracking” in his right shoulder and painful movement rated at 5/10.  The upper extremity PE revealed normal motor, strength, sensation and coordination.  There was marked and palpable cracking with movement but ROM measurements of flexion and abduction were normal and non-painful.  There was no additional limitation in motion with repetition. 
  
The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right shoulder condition 0%, coded 5003 (arthritis, degenerative), citing ROM limited by pain.  The VA also rated the right shoulder condition 0%, coded 5201 (arm, limitation of motion of), based on the C&P evaluation, citing 180 degrees of flexion and abduction, with slightly slow, but pain-free ROM.  The VASRD §4.71a threshold for the minimum 20% rating for limitation of motion (code 5201) is “at shoulder level” (approximately 90 degrees from the side).  The severe ROM limitations noted in the PT ROM study were inconsistent with the normal right shoulder ROMs noted in the earlier orthopedic examination and the post-separation C&P evaluation.  Therefore, panel members apportioned the greatest probative value to the orthopedic examination which supported a 10% rating IAW VASRD §4.59 for painful motion.  There was no malunion or recurrent dislocation of the humerus and no dislocation or nonunion of the clavicle or scapula to justify a higher rating under the 5202 (humerus, other impairment of) or 5203 (clavicle or scapula, impairment of) codes.  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 right shoulder osteoarthritis condition, coded 5299-5003.  

BOARD FINDINGS:  In the matter of the chronic neck pain condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the LBP condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the right shoulder osteoarthritis condition, the panel recommends a disability rating of 10%, coded 5099-5003 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; and, that the discharge with severance pay be re-characterized to reflect permanent disability retirement, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Neck Pain	5299-5237	10%	
Low Back Pain	5299-5237	10%	
Right Shoulder Osteoarthritis	5099-5003	10%	
COMBINED	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170211, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180006525, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

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), XXXXXXXXXXXXXXXXXX.

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

Sincerely,					      
Enclosure