RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02790
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080820

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Construction Equipment Repairer, medically separated for “left muscle Group XXII loss (pre-existing) leading to pain” with a disability rating of 0%.   

CI CONTENTION:  “Feel the issue has not been resolved still have everyday problems.”  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 - 20080731	VARD - 20090413	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Muscle Group XXII Loss (Pre-Existing) Leading to Pain	5322	0%	Cervical Strain	5237	10%	20090105	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Left Muscle Group XXII Loss (Pre-Existing) Leading to Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s left neck condition began when he was 7 years old and he underwent a lymph node dissection on his neck.  He enlisted in November 2006 and in the 12 years between the procedure and his enlistment he had no neck pain.  During advanced training, while performing sit-ups with his neck hanging over a curb, he felt a pop on the right side with immediate pain.  He was treated in sick call where the pain was attributed to the loss of musculature on his left side.  The CI graduated, reported to his new duty station in November 2007, and presented to sick call for a new profile.  In February 2008, physical therapy (PT) was initiated but the condition worsened.  An MRI that month was normal.

During the 15 May 2008 MEB examination (recorded on DD Forms 2807-1 and 2808), 3 months prior to separation, the CI reported he was “not in good health due to his back and neck injury.”  Physical examination showed passive flexion caused neck pain. The cervical spine range of motion (ROM) measurements performed by PT on 10 June 2008, 2 months before separation, showed flexion of 45 degrees (normal) and combined ROM of 325 degrees (normal 340) associated with pain during lateral and rotational measurements. There was no change in ROM after three repetitions.

The 20 July 2008 MEB NARSUM examination, one month prior to separation, noted complaints of physical limitations due to back and neck pain.  Physical examination showed the neck was asymmetric with the right posterior neck tenderness.  Some spasms were noted, but no guarding.  Fatigue, weakness, lack of endurance, and incoordination did not appear to significantly limit functional ability.  Upper extremity strength was 5/5 and sensation was intact.  The examiner stated ROM was consistent with separate measurements (see below).  Cervicalgia was diagnosed, failing retention standards.  The examiner noted the loss of muscle tissue from the left neck was clearly a condition that existed prior to service (EPTS) condition, however the cervicalgia began after he enlisted and was not an EPTS condition. 

At the 5 January 2009 VA Compensation and Pension (C&P) examination, 5 months after separation, the CI reported non-radiating neck pain worsened by moving and lifting.  Physical examination showed no evidence of mass, thyromegaly or bruits.  Lymphadenopathy was present and the surgical scar was well-healed with underlying tissue loss noted on the left side.  The cervical spine appeared normal and there was no muscle spasm or weakness.  There was tenderness in the C7 area.  ROM showed flexion of 45 degrees and combined ROM of 185 degrees with pain at the end points.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left muscle Group XXII loss condition 0%, coded 5322 (Group XXII function), citing slight muscle injury.  The VA rated the cervical condition 10%, coded 5237 (cervical strain) based on the C&P examination, citing evidence of pain on ROM, with reduced combined ROM.

Panel members first discussed the PEB’s coding of the condition.  As noted above, the NARSUM examiner diagnosed and forwarded cervicalgia to the MEB, which in turn, was forwarded to the PEB.  Neither the NARSUM or C&P examiner documented evidence of muscle weakness nor dysfunction to rate higher than 0% (slight), but examinations did record limited painful motion.  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 MEB PT and VA examinations.  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 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 left muscle Group XXII loss, dual coded 5322 5237.  

BOARD FINDINGS:  In the matter of the left muscle Group XXII condition, the panel recommends a disability rating of 10%, dual coded 5322-5237 IAW VASRD §4.71.  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	
Left Muscle Group XXII	5322-5237	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170325, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20190008415, 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