RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00666
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20050923

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

CI CONTENTION:  “My neck and back pain has increased over the years.”  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 - 20050901	VARD - 20061004	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Non-Radiating LBP	5299-5237	10%	DDD Bulge L5-S1 …	5237	10%	STR	
Chronic Radiating Neck Pain	5299-5237	0%	Cervical Spondylosis…	5239	NSC	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Chronic Non-Radiating LBP.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s low back condition began in June 1999 after a motor vehicle accident (MVA).  At the time of the chiropractic clinic appointment on 25 March 2005, 6 months prior to separation, the CI reported he no longer had LBP (0/10; with neck pain 4/10).  On examination there was tenderness along the posterior and paraspinal muscles bilaterally.  Range of motion (ROM) was “near full” and orthopedic and neurological findings were within normal limits.  

At the 10 May 2005 chiropractic clinic appointment, 4 months prior to separation, the CI reported constant, achy LBP (3/10) and stated his symptoms had increased.  Physical examination revealed mild lumbar spine tenderness and minimal tightness in the paralumbars bilaterally.  MRI on 4 August 2005, 2 months prior to separation, revealed a mild broad-based degenerative desiccated disc bulge at L5-S1.  There was no evidence of focal disc protrusion or canal stenosis.  

The 9 August 2005 MEB NARSUM examination, one month prior to separation, noted complaints of chronic LBP.  The physical therapy examination one week later showed the CI walked with a normal gait and had normal strength (5/5).  There was tenderness over L5-S1 and L1-2 and thoracolumbar ROM showed the CI could touch his toes (flexion) and extension was measured at 25 degrees (normal 30) with pain at the end range (combined ROM not greater than 235 degrees of normal 240).  There was no VA examination proximate to separation in evidence.  

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 tenderness.  The VA also rated the condition 10%, using the 5237) code, citing the STR and not meeting the 20% criteria.  

The panel agreed that a 10% rating, but no higher, was justified for tenderness or painful motion with combined ROM (greater than 120 degrees but not greater than 235 degrees), as reported on the MEB NARSUM examination.  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 documentation of intervertebral disc syndrome IVDS) with incapacitating episodes which would provide for a higher rating under that formula.  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 Radiating Neck Pain.  According to the STR and MEB NARSUM, the CI’s neck condition also began in June 1999 after the MVA.  At the time of the orthopedic clinic appointment on 13 April 2005, 5 months prior to separation, the CI reported neck pain.  He denied stiffness, masses, tenderness, enlarged thyroid, enlarged lymph nodes, or rigidity.  On examination he had good extension and rotation of his neck and some tenderness over the facet line.  An MRI on 4 August 2005, 2 months prior to separation, revealed disc desiccation and mild disc bulges were present, extending from C2-3 to C6-7, with no evidence of focal disc protrusion, herniation, significant foraminal narrowing, or canal stenosis.  The cervical spine alignment was mildly straightened secondary to the multilevel spondylitic disc disease.  

The MEB NARSUM examination noted complaints of recurrent neck pain.  The cervical spine ROM measurements performed by PT a day later, showed flexion of over 45 degrees (normal) and combined ROM of 325 degrees (normal 340) after repetition.  At the time of the orthopedic clinic appointment on 16 August 2005, one month prior to separation, the CI reported neck pain.  He stated that injections at C5-C6 in the past gave him 3 months of pain relief.  After that, no other injections gave him long-term pain relief.  Physical examination revealed the CI appeared to be moderately distressed.  Spurling test (for radicular symptoms) and facet tenderness were positive.  Cervical ROM testing showed painful motion was present (no numbers provided) in multiple planes.  

While there was no C&P examination in evidence.  On 10 August 2006, 11 months after separation, there was C&P examiner opinion based on a review of the STR.  The examiner opined that although the CI had evidence of cervicalgia with tenderness and pain-limited ROM, that evidence indicated the CI had the condition prior to being placed on orders and there was no significant worsening during that period of service.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the neck condition 0%, analogously coded 5237 (cervical strain), citing “exam shows full motion,” and rated for motion without tenderness.  The VA rated the neck condition as not service connected, based on the STR, citing “no increment of the disability while in military service…just a recurrence of the [pre-existing] condition.”

The panel agreed that a 10% rating, but no higher, was justified for limitation of combined ROM (greater than 170 degrees but not greater than 335 degrees), as reported on the MEB NARSUM examination.  Alternatively a 10% rating was supported by painful motion as noted on the NARSUM and at the orthopedic clinic appointment following the NARSUM (which also recorded tenderness).  While the CI may have experienced radiating pain from the neck condition, this is subsumed under the general spine rating criteria, which specifically states “with or without symptoms such as pain (whether or not it radiates).”  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 documentation of IVDS with incapacitating episodes which would provide for a higher rating under that formula.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the neck condition, coded 5299-5237.  

BOARD FINDINGS:  In the matter of the low back condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the neck condition, the panel recommends a disability rating of 10%, coded 5299-5237 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 the date of medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Non-Radiating Low Back Pain	5299-5237	10%	
Chronic Radiating Neck Pain	5299-5237	10%	
COMBINED	20%	

AR20190004011, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear  XXXXXXXXXXXXXXXXXX

The Department of Defense Physical Disability Board of Review (DoD PDBR)
reviewed your application and found that your disability rating should be modified but
not to the degree that would justify changing your separation for disability with
severance pay to a permanent retirement with disability. I have reviewed the Board’s
recommendation and record of proceedings (copy enclosed) and I accept its
recommendation. This will not result in any change to your separation document or the
amount of severance pay. A copy of this decision will be filed with your Physical
Evaluation Board records. I regret that the facts of the case did not provide you with the
outcome you may have desired.
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.
A copy of this decision has also been provided to the Department of Veterans
Affairs.