RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01914
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070620

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty 0-4, Medical-Surgical Nurse, medically separated for “chronic neck pain” and “low back pain,” rated 10% and 0% respectively, with a combined disability rating of 10%.   

CI CONTENTION:  Review of all conditions requested. 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 - 20070503	VARD - 20070920	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Neck Pain	5237	10%	DDD, Cervical Spine	5242	20%	20070619	
Low Back Pain (LBP)	5237	0%	Degenerative Arthritis, Lumbar Spine	5003	10%	20070619	
Sensori-Neural Hearing Loss	Not Unfitting	Bilateral Hearing Loss	6100	0%	20070619	
Occasional Left Knee Pain	Not Unfitting	Status Post Left Meniscal Tear with Patellofemoral Syndrome, Left Knee	5260	0%	20070619	
History of Torn Meniscus Left Knee	Not Unfitting					
Mild Seasonal Allergies	Not Unfitting	Seasonal Allergies	6522	NSC	20070619	
Gastroesophageal Reflux Disease	Not Unfitting	Gastroesophageal Reflux Disease 	7346	0%	20070619	
Past History of Hypothyroidism	Not Unfitting	No VA Placement	
History of Fasciitis Resolved	Not Unfitting	No VA Placement	
Bereavement without Complications	Not Unfitting	No VA Placement	
Bifocals	Not Unfitting	No VA Placement	
COMBINED RATING:  10%	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 after striking her head on a windshield after an automobile accident in 1986.  She first noticed problems with pain in her neck and numbness radiating into her right little finger after doing ruck marches with body armor and Kevlar helmet in 2002 during combat medic training.  X-rays in November 2005 showed multilevel degenerative disk disease (DDD) at C4-T1, with mild kyphosis centered at C4-5.  MRI of the cervical spine done in November 2006 showed severe DDD at C4-5, C5-6 and C6-7.  There was mild stenosis at C4-5 and moderate stenosis at C5-6 and loss of normal lordosis.  

The 8 March 2007 MEB NARSUM examination, 3 months prior to separation, noted complaints of constant neck pain.  In the morning, the pain level varied from 2-4/10, by the end of the daythe pain level was at 5-6/10.  Physical examination showed tenderness, but the CI had normal gait, motor strength and sensory function in the upper extremities.  The cervical spine range of motion (ROM) measurements were reported as flexion “approximately half” of what the examiner expected.  Extension was near full, and right and left rotation were 45 degrees (normal 80) with painful motion.  

At the 19 June 2007 VA Compensation and Pension (C&P) examination, one day before separation, the CI reported constant steady pain with intermittent sharp stabbing pain over a chronic dull ache.  Physical examination showed tenderness, but no spasm and a normal gait and spinal contour.  The cervical spine ROM measurements showed flexion of 30 degrees (normal 45) and combined ROM of 205 degrees (normal 340), after repetition, and were associated with painful motion.  

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 limitation of motion due to pain.  The VA rated the neck condition 20%, coded 5242 (degenerative arthritis of the spine), based on the C&P examination, citing forward flexion of the cervical spine greater than 15 degrees but not greater than 30 degrees.  

The panel agreed that a 20% rating, but no higher, was justified for limitation of flexion (greater than 15 degrees but not greater than 30 degrees) as noted by the VA in their examination which was most proximate to separation.  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 recommends a disability rating of 20% for the neck condition, coded 5237.  

LBP.  According to the STR and MEB NARSUM, the CI’s back condition began in 2004 while on vacation in Florida.  She had been moving heavy suitcases and awoke the following morning with pain and numbness in her left leg.  An MRI done in August 2004 showed a disc bulge at L4-L5 which did not result in significant neural compromise or canal stenosis and a disc protrusion at L5-S1, but X-rays done in November 2005 showed no significant abnormality.  

The 13 February 2007 MEB examination (recorded on DD Forms 2807-1 and 2808), 4 months prior to separation, showed tenderness and decreased ROM.  During the MEB NARSUM examination, 3 months prior to separation, the CI complained of LBP.  Physical examination revealed a normal gait, no tenderness, and “excellent” ROM.  At the 21 February 2007 physical therapy (PT) ROM examination, the CI demonstrated 110 degrees of flexion (normal 90) and 30 degrees of extension (normal) and no painful motion.

During the C&P examination, one day before separation, the CI reported low lumbar back pain that radiated into the buttocks, but only occurred after sitting too long, moving the wrong way, or twisting.  Physical examination showed no objective evidence of painful motion, spasm, weakness or tenderness.  Thoracolumbar ROM measurements showed flexion of 90 degrees and combined ROM of 240 degrees (normal) and there was no additional limitation with repetitive motion.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 0%, coded 5237 (lumbar spine strain), citing excellent ROM and no tenderness, muscle spasm or radiculopathy.  The VA rated the back condition 10%, coded 5003 (degenerative arthritis), based on the C&P examination, citing painful or limited motion of a major joint or group of minor joints.  

There was no limitation of thoracolumbar spine motion to support a 10% rating under the General Rating Formula for Diseases and Injuries of the Spine and the VA C&P pre-separation examination did not note the presence of painful motion, muscle spasm, guarding, or localized tenderness.  There was no history or evidence of vertebral body fracture with loss of 50 percent or more of the height, nor was there evidence of additional functional loss that would impact functioning in the average civil occupation.  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 concluded there was insufficient cause to recommend a change in the PEB adjudication for the back condition.  

Contended PEB Conditions:  Sensori-Neural Hearing Loss, Occasional Left Knee Pain, History of Torn Meniscus Left Knee, Mild Seasonal Allergies, GERD, Past History of Hypothyroidism, History of Fasciitis Resolved, Bereavement without Complications, and Bifocals.  The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting.  Only the hearing loss was profiled, none of the conditions were implicated in the commander’s statement and none failed retention standards.  There was no performance-based evidence from the record that any of the conditions 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 determinations for any of the contended conditions, so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the neck condition, the panel recommends a disability rating of 20%, coded 5237 IAW VASRD §4.71a.  In the matter of the back condition, the panel recommends no change in the PEB adjudication.  In the matter of the contended sensori-neural hearing loss, left knee pain, torn meniscus left knee, seasonal allergies,; GERD, hypothyroidism, fasciitis resolved, bereavement without complications, and bifocals, 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, effective the date of medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Neck Pain	5237	20%	
Low Back Pain	5237	0%	
COMBINED	20%	

AR20190007027, 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.