RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00646
BRANCH OF SERVICE:  army 	SEPARATION DATE:  20090327

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a National Guard E3, Human Resources Specialist, medically separated for “chronic neck pain” and “chronic low back pain,” rated 10% each, with a combined disability rating of 20%.  

CI CONTENTION:  “Review all conditions.”  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 - 20081230	VARD - 20100423	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Neck Pain	5237	10%	Cervicalgia	5237	NSC	20091029	
Chronic Low Back Pain	5237	10%	Lumbar Spine L5-S1 Disc Protrusion	5237	10%	20091029	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Chronic Neck Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s neck condition began in February 2007 after falling onto her back during obstacle course training.  Cervical spine MRI was normal.  At the 4 February 2008 physical therapy (PT) clinic appointment, the examiner recorded active flexion to 45 degrees (normal) and combined range of motion (ROM) of 250 degrees (normal 340).  At the PT examination on 15 May 2008, 10 months prior to separation, there was tenderness, but cervical spine ROM was judged as normal.  At the 18 September 2008 MEB NARSUM examination, 6 months prior to separation, the CI complained of radiating neck pain.  The examiner noted painful motion but no tenderness or spasms.  ROM measurements, after repetition, indicated flexion to 45 degrees and combined ROM of 245 degrees.  

At the 29 October 2009 VA Compensation and Pension (C&P) evaluation, 7 months after separation, the CI reported radiating neck pain, limited ROM and stiffness.  The examiner noted painful motion with flexion of 45 degrees and combined ROM of 265 degrees.  There was no additional limitation with repetitive motion.  There was no joint swelling, effusion, tenderness or laxity and gait was normal.  X-rays on 29 October 2009 showed some loss of normal lordotic curvature on an otherwise unremarkable cervical spine series.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the neck condition 10%, coded 5237 (cervical strain), citing flexion of 44 degrees with no tenderness, muscle spasm, radiculopathy or deformity.  The VA did not service-connect the neck condition, citing failure to show evidence of chronic disability.  The panel agreed that a 10% rating, but no higher, was justified for combined ROM (greater than 170 degrees but not greater than 335 degrees), as reported on the MEB NARSUM and VA C&P examinations proximate to separation.  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 neck condition.  

Chronic Low Back Pain (LBP).  According to the STR and MEB NARSUM, the CI’s back condition began in February 2007 after a fall on an obstacle course as noted above for the neck.  Lumbar MRI showed minimal posterior central protrusion at L5-S1.  The PT examination on 4 February 2008 noted normal gait and heel/toe walk with lower back tenderness.  Active ROM recorded as “forward flexion to the toes” and “extension mild decrease with pain.”  The follow-up PT examination on 15 May 2008 showed trunk flexion with fingers reaching to the toes with a severe decrease in extension and more pain going to the right with side bends.  

The 18 September 2008 MEB NARSUM examination noted complaints of LBP.  The examiner noted painful motion and recorded active flexion of 90 degrees (normal) and combined ROM of 230 degrees (normal 240).  There was no additional limitation with repetitive motion.  At the 21 October 2008 pain clinic, the examiner recorded active flexion to 80 degrees.  

At the 29 October 2009 C&P evaluation the CI reported LBP and spasms.  The examiner noted painful motion and recorded active flexion of 100 degrees and combined ROM of 210 degrees.  There was no additional limitation with repetitive motion.  X-ray on 29 October 2009, showed some loss of the normal lordotic curvature.    

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, coded 5237 (lumbosacral strain), citing painful motion.  The VA also rated the back condition 10%, coded 5237, based on the C&P examination, citing a combined ROM of 220 degrees.  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) or combined ROM (greater than 120 degrees but not greater than 235 degrees), as reported on the MEB NARSUM, VA C&P and pain clinic 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 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 back condition.  

BOARD FINDINGS:  In the matter of the neck condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the back condition and IAW VASRD §4.71a, 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 20170221, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20180004725, 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