RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01905
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070518

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6, Wheeled Vehicle Mechanic, medically separated for “chronic neck pain,” “chronic mid back pain” and “chronic left shoulder tendinitis,” rated 10%, 10% and 0%, respectively, with a combined disability rating of 20%.  

CI CONTENTION:  “I am still having back and neck issues.  Have been to acupuncturist, chiropractors.  Have the state of art equipment for a tens unit as well as alpha stem for the migraines with many meds.  The VA rate just the fibromyalgia a 40%.”  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 - 20070405	VARD - 20071217	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Neck Pain	5237	10%	Degenerative Disc Disease, Cervical Spine	5243	10%	20070504	
Chronic Mid Back Pain	5237	10%	Degenerative Disc Disease, Thoracic Spine	5243	10%		
Left Shoulder Tendinitis	5024	0%	Sprain, Left Shoulder	5299-5203	10%		
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  80% 	

ANALYSIS SUMMARY:  

Chronic Neck Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s neck condition began in 2003 and was associated with multiple episodes of left shoulder trauma.  An MRI on 18 November 2005 revealed right-sided C6-7 nerve root enlargement and mild multi-level degenerative disk disease.  A repeat MRI in November 2006 was “normal” with “no significant degenerative disease associated with the osseous [boney] structures.”  During the 30 November 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 6 months prior to separation, the CI reported “chronic left shoulder pain and nerve damage in neck which causes my left arm and hand to go numb.”  At the 7 December 2006 MEB NARSUM examination, 5 months prior to separation, the CI complained of chronic neck pain.  Her physical examination (PE) revealed tenderness and painful motion.  On 10 January 2007, physical therapy (PT) measured cervical range of motion (ROM) as normal forward flexion (45 degrees) and combined ROM of 210 degrees (normal 340) with painful motion.  An MRI of the total spine performed on 13 February 2007 was normal.  

The 4 May 2007 VA Compensation and Pension (C&P) evaluation, 2 weeks before separation, revealed normal forward flexion, but combined ROM was 330 degrees.  There was no additional limitation, instability, weakness or incoordination upon repetition.  There was no radiculopathy reported and X-ray studies indicated mild arthritic changes of the cervical spine.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the neck condition 10%, coded 5237 (cervical spine strain), citing tenderness.  The VA also rated the neck condition 10%, coded 5243 (intervertebral disc syndrome), citing criteria for rating diseases and injuries of the spine.  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 examinations proximate to separation.  There was no evidence of 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 evidence of intervertebral disc syndrome (IVDS) which resulted in incapacitating episodes requiring physician-prescribed bed rest to warrant consideration of rating under the alternate VASRD formula for that condition.  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’s adjudication for the neck condition.

Chronic Mid Back Pain.  According to the STR and the MEB NARSUM, the CI’s back condition began in August 2002 after heavy lifting.  The CI was seen by PT in April 2004 and reported falling out of a military vehicle in November 2003.  Her PE showed full ROM of the thoracic spine with mild pain and no tenderness.  During the 30 November 2006 MEB examination the CI indicated she had a history of back pain, numbness or tingling.  The examiner reported an abnormal spine and that axial loading resulted in thoracic spine pain.  Clinical tests were negative for radiculopathy.  X-rays performed on 17 January 2007 noted a normal thoracic spine.  

At the 7 December 2006 MEB NARSUM examination the CI complained of upper and mid-level back pain.  Her PE revealed tenderness without evidence of spasms.  Spinal flexion and extension were documented as “abnormal” and painful motion was present.  A total spine MRI on 13 February 2007 was normal. On 22 March 2007, the PT thoracolumbar ROM study showed forward flexion of 90 degrees (normal) with combined ROM of 220 degrees (normal 240).  

The 4 May 2007 C&P evaluation noted complaints of low back pain.  Her PE showed a slight antalgic gait to the left side and mild spasm along the thoracic spine without abnormal spinal contour.  Thoracolumbar ROM measurements noted forward flexion of 85 degrees and a combined ROM of 220 degrees (normal 240).    

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 localized tenderness.  The VA also rated the back condition 10%, coded 5243 (IVDS), citing criteria for rating diseases and injuries of the spine.  The panel majority agreed that the evidence of both the presence of thoracic spasms coupled with an antalgic gait at 2 weeks prior to separation would support VASRD criteria for a 20% rating.  There was no evidence of limitation of motion of 30 degrees or less, thus the next higher 40% rating was not justified on this basis.  There was no additional evidence of IVDS which resulted in incapacitating episodes requiring physician-prescribed bed rest to warrant consideration of rating under the alternate VASRD formula for that condition.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel majority recommends a disability rating of 20% for the back condition. 

Chronic Left Shoulder Tendinitis.  According to the STR and the MEB NARSUM, the CI’s left shoulder condition began in November 2002 after a fall.  An MRI of the shoulder performed in January 2005 showed a probable tendon injury.  An Orthopedic evaluation performed on 7 April 2005 revealed painful and decreased left shoulder ROM with forward flexion and abduction at 150 degrees (normal 180).  A follow-up orthopedic examination on 2 November 2005 reported the same ROM measurements and testing results.  The CI underwent specialized radiologic procedures as well as electro-diagnostic testing; all of which were reported as normal.  

A PT encounter on 10 January 2007 documented left shoulder ROM as forward flexion to 135 degrees and abduction to 112 degrees.  According to the 13 February 2007 MEB NARSUM evaluation the CI complained of left shoulder pain.  Shoulder dislocations were not reported.  Her PE showed no evidence of joint instability.  Left shoulder flexion as well as abduction were 150 degrees.  Tenderness and painful motion were present.  

At the 4 May 2007 C&P evaluation the PE revealed normal forward flexion of the left shoulder and near normal abduction of 170 degrees.  Painful motion was present.  The examiner gave a diagnosis of “symptomatic left shoulder pain secondary to mild tendinitis of the left shoulder without partial thickness tear found.  Arthritis of left shoulder, not found.” 
 
The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left shoulder condition 0%, coded 5024 (tenosynovitis), citing localized tenderness.  The VA rated the left shoulder condition 10%, analogously coded 5203 (clavicle or scapula, impairment of), citing “demonstrable pain on motion.”  The VASRD §4.71a threshold for rating for ROM impairment (code 5201, arm limitation of motion) is “at shoulder level” (approximately 90 degrees from the side), and the examinations in evidence demonstrated motion above this level.  However, panel members agreed that a 10% rating was justified with application of VASRD §4.59 (painful motion) as noted in the examinations proximate to separation.  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 code 5202 (other impairment of humerus) or 5203 (impairment of clavicle or scapula).  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 left shoulder 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, the panel majority recommends a disability rating of 20%, coded 5237 IAW VASRD §4.71a; the single voter for dissent recommends no change, but elected not to submit a minority opinion.  In the matter of the left shoulder 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	5237	10%	
Chronic Mid Back Pain	5237	20%	
Chronic Left Shoulder Tendinitis	5099-5003	10%	
COMBINED	40%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170301, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20180005893, 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 40% 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 also been provided to the Department of Veterans Affairs.
 
Sincerely,					      
Enclosure