RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02127
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20051215

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a National Guard E7, Human Resource Specialist, medically separated for “chronic traumatic cervical and thoracic myofascial pain” with a disability rating of 10%.  

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 - 20050726	VARD - 20060824	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Traumatic Cervical and Thoracic Myofascial Pain	5237	10%	Chronic Sprain, Cervical Spine	5237	20%	20060505	
			Mild Thoracic Scoliosis and Lumbar Sprain	5237	10%	20060505	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Chronic Traumatic Cervical and Thoracic Myofascial Pain.  The PEB combined the cervical and thoracic conditions under a single disability rating, coded 5237 (lumbosacral or cervical strain) and rated 10%.  This approach by the PEB not uncommonly reflected its judgment that the constellation of conditions was unfitting, and there was no need for separate fitness adjudications.  The panel’s initial charge in this case was therefore directed at determining if combining conditions under a single rating was justified in lieu of separate ratings (IAW VASRD §4.71a, the general spine formula, note 6, the disability of the thoracolumbar and cervical spine segments are separately evaluated, except when there is unfavorable ankylosis of both segments, which will be rated as a single disability).  When considering a separate rating for each condition, the panel considers each bundled condition to be reasonably justified as separately unfitting unless a preponderance of evidence indicates the condition would not cause the member to be referred into the DES or be found unfit because of physical disability.  When the panel recommends separate fitness recommendations in this circumstance, its recommendations may not produce a lower combined rating than that of the PEB.  

According to the service treatment record and MEB narrative summary (NARSUM), the CI’s neck and back conditions began in December 1998 after being involved in a motor vehicle accident (MVA).  Both conditions were then aggravated by subsequent MVAs in September 1999 and November 2003.  The 22 April 2005 MEB NARSUM examination, 8 months prior to separation, noted complaints of intermittent neck and back pain, both with occasional spasms.  Physical examination showed cervical tenderness and decreased cervical lordosis on extension.  The cervical spine range of motion (ROM) measurements performed by physical therapy using a goniometer showed flexion of 20 degrees (normal 45) and combined ROM of 240 degrees (normal 340) after repetition, with associated painful motion.  There was thoracic tenderness over the levator scapular and rhomboid muscles, and discomfort over the inter-scapular area with shoulder motion.  Thoracolumbar ROM measurements recorded active flexion to 90 degrees (normal) and combined ROM of 240 degrees (normal) after repetitive motion, with associated painful motion.  No spasm or muscle atrophy was noted in either spine segment.  

At the 5 May 2006 VA Compensation and Pension (C&P) examination, 5 months after separation, the CI reported stiffness and intermittent pain of the neck, upper back, and thoracic areas.  Physical examination showed a normal gait and posture, and tenderness at the C5-C7 level.  Spine X-rays showed mild thoracic spine scoliosis.  The examiner recorded active cervical flexion to 30 degrees with a combined ROM of 140 degrees after repetition, with pain limited motion.  Thoracolumbar evaluation revealed tenderness and active flexion to 80 degrees, with a combined ROM of 230 degrees, after repetition.  The examiner noted that thoracolumbar ROM was not additionally limited by pain, fatigue, weakness, lack of endurance, or incoordination.  

The panel directed attention to its rating recommendation based on the above evidence.  As noted previously, the PEB combined the cervical and thoracic conditions under a single disability rating, coded 5237 and rated 10%, citing decreased cervical flexion of 24 degrees, limited by pain, with likely application of AR 635-40, B-29 in effect at the time; there was no muscle atrophy or radiculitis.  The VA rated the cervical condition 20%, coded 5237, based on the C&P examination, citing cervical forward flexion greater than 15 degrees but not greater than 30 degrees.  The VA rated the back condition 10%, coded 5237, based on the C&P examination, citing flexion limited to 80 degrees.  

In this case, both the neck and the back conditions were separately considered to fail retention standards (separately listed on the MEB), were implicated by the NARSUM, and were separately profiled.  Members agreed that the evidence reasonably justified that the functional limitations of each condition contributed to the CI’s inability to perform his military duties; each was reasonably unfitting, and accordingly a separate disability rating is recommended for each.  

The panel agreed that a cervical spine 20% rating, but no higher, was justified for limitation of flexion (greater than 15 degrees but not greater than 30 degrees) as reported on the NARSUM and VA C&P examinations.  Members also adjudged that a thoracolumbar spine 10% rating, but no higher, was justified for painful motion or tenderness as reported on the NARSUM examination or limitation of flexion (greater than greater than 60 degrees but not greater than 85 degrees) as reported on the VA C&P 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 for the back was not justified on this basis.  There was no documentation of intervertebral disc syndrome with incapacitating episodes which would provide for a higher rating for either spine segment under that formula.  After due deliberation, and considering all the evidence, the panel recommends a disability rating of 20% for the neck condition, and a disability rating of 10% for the back condition, each coded 5237.  

BOARD FINDINGS:  In the matter of the combined cervical and thoracic spine condition, the panel recommends that each spine segment be separately adjudicated as follows: an unfitting cervical spine condition coded 5237 and rated 20%, and an unfitting thoracolumbar spine condition, coded 5237 and rated 10%, both 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 the date of medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Traumatic Cervical Myofascial Pain	5237	20%	
Chronic Traumatic Thoracic Myofascial Pain	5237	10%	
COMBINED	30%	

The following documentary evidence was considered:  

Exhibit A.  DD Form 294, dated 20170228, w/atchs  
Exhibit B.  Service Treatment Record  
Exhibit C.  Department of Veterans Affairs Record  

AR20190007262, 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 30% 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.
 
	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), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557.

	A copy of this decision has also been provided to the Department of Veterans Affairs.

Sincerely,					      
Enclosure