DEPARTMENT OF THE NAVY
SECRETARY OF THE NAVY COUNCIL OF REVIEW BOARDS
720 KENNON STREET SE STE 309
WASHINGTON  NAVY  YARD  DC 20374-5023

IN REPLY REFER TO

1850
CORB:003
19 Feb 20

From: To:

Director, Secretary of the Navy Council of Review Boards 
PD-2017-01388 

Subj: .PHYSICAL DISABILITY BOARD OF REVIEW (PDBR)

Ref:	(a) DoDI 6040.44
(b) PDBR ltr of 28 Oct 19

1.	Pursuant to reference (a), the PDBR reviewed your case and forwarded its recommendation (reference (b)) to the Department of the Navy for appropriate
·action.

2.	On 12 February 2020, the Assistant Secretary of the Navy took action in your case by accepting the correct recommendation of the PDBR.	Accordingly, your records will be corrected to reflect an increase in the disability rating awarded by the Physical Evaluation Board from Oto	30 percent with assignment to the Permanent Disability Retired List.

3.	The Assistant Secretary's determination, which represents final action in your case by the Department of the Navy, was sent to the Navy Personnel Command, for correction of your records as stated above.	You will be notified once those changes are complete.

RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME: XXXXXXXXXX	CASE: PD-2017-01388
BRANCH OF SERVICE: NAVY	SEPARATION DATE: 20090428

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6, Auxiliary Equipment Technician, medically separated for “chronic thoracic pain” with a disability rating of 0%.

CI CONTENTION: “Review all conditions, including mental health.” 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 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 - 20090209	VARD - 20100322	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Thoracic Pain	5299-
5237	0%	DDD, Thoracic Spine	5242	20%	
20091013	
DDD, C5-6	Cat III	DDD with history of Bilateral Radiculopathy, Cervical Spine	5242	20%		
Depressive Disorder NOS		No VA Placement	
Dependent and Paranoid Personality Traits	Cat IV		
COMBINED RATING: 0%	COMBINED RATING OF ALL VA CONDITIONS: 40%	

ANALYSIS SUMMARY:

Chronic Thoracic Pain. According to the service treatment record and MEB narrative summary (NARSUM), the CI’s back pain was a long-standing condition that was exacerbated by increases in running and training in June 2007. He also had concomitant cervicalgia (see below). Examination on 9 July 2007 revealed tenderness of the thoracic spine and paraspinal muscles, and pain on extension. A thoracic spine examination 4 days later was unchanged and there was tenderness of the lumbosacral spine. A 21 July 2008 examination revealed tenderness of the thoracic spine with full range of motion (ROM) and no pain. Gait and stance were normal. Medication, physical therapy, a TENS (transcutaneous electrical nerve stimulation) unit, manipulation therapy  and trigger  point injections failed  to resolve  his  symptoms  and    allow

continued duty in his specialty.  X-rays of the thoracic spine dated 1 August 2007 were normal.  A 20 August 2007 examination revealed pain at T3 and T4 vertebrae.

At the 13 February 2008 VA Compensation and Pension (C&P) examination, 14 months before separation, the CI reported daily back pain for the prior 5 years. Physical examination showed flexion of 50 degrees (normal 90) and combined ROM of 150 degrees (normal 240). Gait and station were noted as normal. Thoracic spine X-rays showed degenerative arthritis and a convex right scoliotic curvature. Lumbar spine X-rays findings were within normal limits.

The 9 October 2008 MEB NARSUM examination, 6 months prior to separation, noted complaints of bilateral, upper extremity pain and numbness with associated right parascapular pain greater than left. The examiner’s diagnosis was degenerative disc disease (DDD) at C5-6 (see below) and chronic thoracic pain. At the 13 October 2009 C&P examination, 6 months after separation, the CI reported daily back pain without flare-ups or incapacitating episodes. Physical examination showed flexion of 40 degrees and combined ROM of 160 degrees. Gait and station were noted as normal. X-rays showed minimal scoliosis at T6-T7. At the 5 November 2009 VA physical medicine rehabilitation (PMR) consultation appointment the CI complained of constant back pain described as a sense of tension and aching bilaterally in the midline of the low and middle back. Symptoms were worse with forward bending, twisting, lifting, and prolonged walking activities. Physical examination noted a normal gait, paraspinal tenderness, pain-limited flexion to 45 degrees, mild pain on extension, and no pain with side bending.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the thoracic condition 0%, analogously coded 5237 (lumbosacral strain). The VA rated the thoracic spine DDD 20%, coded 5242 (degenerative arthritis of the spine), based on the C&P examination, citing forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees.

The panel agreed that a 20% rating, but no higher, was justified for limitation of flexion (greater than 30 degrees but not greater than 60 degrees) as reported on the VA examinations both pre- and post-separation. There was no documentation of intervertebral disc syndrome 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 20% for the thoracic condition, coded 5299-5237.

Contended Category III Conditions: C5-6 DDD, and Depressive Disorder Not Otherwise Specified (NOS), and Category IV Condition: Dependent and Paranoid Personality Traits. The panel’s main charge is to assess the fairness of the PEB’s determination that contended conditions were not unfitting.

C5-6 DDD. The CI was seen in the emergency room in July 2007 with bilateral arm numbness. He had full ROM of the neck. X-rays in August 2007 showed reversed lordosis suggesting muscle spasm, but were otherwise normal. An MRI in October 2007 showed mild disc disease at C6-7 with a mild right lateral disc protrusion slightly deforming the thecal sac and nerve sleeve. There was a reversed lordotic curvature indicative for muscle spasm and mild disc disease at C4-5 and C5-6 with a bulging annulus but no neuro-compression. An orthopedic examination in November 2007, noted right arm radicular symptoms of C7 versus C8. Some relief of symptoms was obtained with traction. However, despite medication, physical and manipulative therapies, the neck pain persisted.

At the VA examination on 13 February 2008, 14 months prior to separation, cervical spine ROM flexion was 15 degrees (normal 45) and combined ROM 215 degrees (normal 340) with painful motion. At the 5 November 2009 VA PMR consultation appointment, 7 months after separation, the CI complained  of severe  neck pain with radiation to the right arm.       Physical examination

showed full flexion. Rotation was limited to 45 degrees (normal 80) bilaterally without significant pain. Extension was limited to 60 degrees (normal 45) with pain. There was diffuse spinal and paraspinal tenderness. An MRI dated 19 February 2009 demonstrated very mild annular disc bulging at C5-C6 and C6-C7 with no evidence of focal disc protrusion or significant stenosis. Right upper extremity electrodiagnostic studies on 8 December 2009 were essentially normal.

After due deliberation, the panel agreed the preponderance of the evidence with regard to the functional impairment of the C5-6 DDD favors its recommendation as an additionally unfitting condition for disability rating. The panel agreed that the PMR consultation was most probative; and based on the diffuse spinal and paraspinal tenderness, the condition is appropriately coded 5242 (degenerative arthritis) and meets the VASRD §4.71a criteria for a 10% rating.

Depressive Disorder NOS. The contended condition was not noted on limited duty forms, implicated in the non-medical assessment and did not fail retention standards. There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation. After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for the contended depressive disorder NOS so no additional disability rating is recommended.

Dependent and Paranoid Personality Traits. The dependent and paranoid personality traits are not a condition not constituting a physical disability, IAW DoDI 1332.38. Therefore, the panel has no basis for recommending this as unfitting.

BOARD FINDINGS: In the matter of the thoracic pain, the panel recommends a disability rating of 20%, coded 5299-5237 IAW VASRD §4.71a. In the matter of the contended C5-6 degenerative disc disease condition, the panel agrees it was unfitting and recommends a disability rating of 10%, coded 5242 IAW VASRD §4.71a. In the matter of the contended depressive disorder (NOS) and dependent and paranoid and personality traits, the panel recommends no change from the PEB determinations as not unfitting. 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 the date of medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Thoracic Pain	5299-5237	20%	
C5-6 Degenerative Disc Disease	5242	10%	
	COMBINED	30%