RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  xxxxxxxxxxxxxxxxxx	CASE:  PD-2017-02699
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20060222

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5 , Motor Transport Operator, medically separated for “chronic low back pain” and “chronic neck pain,” rated 10% and 0%, respectively, with a combined disability rating of 10%.

CI CONTENTION:  “Conditions not treated properly resulting in more severe pain, lack of motion and strength.”  The CI also requested review of additional conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB).  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 - 20051028	VARD - 20060620	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5299-5237	10%	Lumbosacral Strain	5237	10%	20060509	
Chronic Neck Pain	5299-5237	0%	Cervical Strain	5237	10%	20060509	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s back condition began in 1999 after weight lifting, but while deployed in 2004, the pain became progressively worse after falling off a vehicle.  Lumbar spine X-rays were normal, but an MRI revealed a disc bulge at L4-5.  A primary care examination on 15 March 2005, 11 months prior to separation, revealed normal spinal curvature and “full” range of motion (ROM) in all planes without pain.  The 19 May 2005 MEB NARSUM examination, 9 months prior to separation, noted complaints of back pain with daily activities.  Physical examination showed no back tenderness or spasms.  There was pain-limited motion, but it was not quantified.  ROM testing by physical therapy (PT) on 31 May 2005 showed flexion of 30 degrees (normal 90) and combined ROM of 155 degrees (normal 240) with painful motion.

At the 9 May 2006 VA Compensation and Pension (C&P) examination, 3 months after separation, the CI reported light back tenderness and frequent back pain that radiated to the left leg.  There were no incapacitating episodes with bed rest or hospitalization ordered by a physician.  Physical examination showed a normal gait and posture.  Repetitive flexion was 90 degrees and combined ROM was 220 degrees with painful motion.  There was no additional ROM loss due to pain, weakness, fatigability, or incoordination following repetitive use (DeLuca testing).

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, analogously coded 5299-5237 (lumbosacral strain), citing back tenderness and passive limitation of flexion.  The VA also rated the back condition 10%, coded 5237, based on the C&P examination, citing painful limitation of motion.  The panel deliberated and determined the VA ROM examination had the highest probative value because it was most proximate to separation, measured repetitive motion and included DeLuca ROM testing.  The panel agreed that a 10% rating, but no higher, was justified for combined ROM (greater than 120 degrees but not greater than 235 degrees).    The panel considered the MEB PT examination an outlier since the preponderance of STR and VA ROM evidence, proximate to separation, did not support a rating higher than 10%.  Additionally, 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 back condition.  

Chronic Neck Pain.  According to the STR and MEB NARSUM, the CI’s neck condition began in 2004 after wearing heavy equipment.  A cervical spine MRI in May 2004 showed mild cervical lordosis (straightening likely secondary to spasms versus neck positioning).  A primary care examination on 15 March 2005, 11 months prior to separation, revealed normal spinal curvature and “full” cervical ROM in all planes without pain.  The MEB NARSUM examination noted no significant neck pain improvement.  Physical examination showed no spasms but tenderness was present.  There was pain-limited neck motion, but it was not quantified.  The 31 May 2005 MEB ROM evaluation by PT, after repetitive movement, showed cervical flexion of 40 degrees (normal 45) and combined ROM of 300 degrees (normal 340) with painful motion.

At the C&P examination, the CI complained of neck tenderness and pain with any movement.  Physical examination revealed a normal gait and posture. The CI was able to “touch his chin to his chest” (approximating normal flexion of 45 degrees) and combined ROM was approximately 285 degrees with painful motion.  There was no ROM loss following repetitive use.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the neck condition 0%, analogously coded 5299-5237, citing tenderness.  The VA also rated the neck condition 10%, coded 5237, based on the C&P examination, citing limitation of combined ROM with painful motion.  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), or painful motion (VASRD §4.59), as reported on the VA examination most proximate to separation.  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 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 Low Back Pain	5299-5237	10%	
Chronic Neck Pain	5299-5237	10%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170213, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR20190009138, 

Dear XXXXXXXXXXXXXX:

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.