RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03218
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060719 

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty  E4, Infantryman, medically separated for “chronic neck pain” and “chronic low back pain,” rated 10% and 0%, respectively, with a combined disability rating of 10%.   

CI CONTENTION:  “I feel the combined ratings were low for my given condition at the time of separation.  I was also unaware of other conditions I could claim at the time of separation.  This includes PTSD, Gulf War Syndrome and hearing to name a few conditions.  All of which were present at the time of discharge, but ignored by the P.E.B. and Fort Bragg medical staff.”  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 - 20060409	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Neck Pain	5299-5237	10%	No VA Examination in Evidence Proximate to Separation	
Chronic Low Back Pain	5237	0%		
COMBINED RATING: 10	COMBINED RATING OF ALL VA CONDITIONS:  NA 	

ANALYSIS SUMMARY:  

Chronic Neck Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s neck condition began in December 2004 after he was involved in a motor vehicle accident (MVA).  In March 2005, X-rays revealed straightening and slight reversal of the normal lordotic curvature of the cervical spine with no fracture or subluxation noted.  Magnetic resonance imaging (MRI) performed in October 2005 revealed scattered degenerative arthritis. 

During the 18 January 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 6 months prior to separation, the CI reported neck pain.  The physical examination (PE) revealed painful motion of the cervical spine, but neck range of motion (ROM) measurements were not recorded.  On 20 January 2006, the MEB physical therapy (PT) study recorded normal flexion, extension, and right sided lateral flexion of the cervical spine.  Left lateral flexion was decreased at 30 degrees (normal 45) as well as right and left rotation at 60 and 65 degrees, respectively (normal 80 degrees each direction); combined cervical ROM was 290 degrees (normal 340).  

At the 13 March 2006 MEB NARSUM examination, 4 months before separation, the CI continued to complain of neck pain.  The PE revealed cervical spine tenderness as well as painful motion.  The examiner repeated the January PT ROM measurements.  There was no VA Compensation and Pension evaluation in evidence proximate to separation.   

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the neck condition 10%, analogously coded 5237 (cervical spine strain), citing painful motion and tenderness.  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), as reported on the PT examination 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 intervertebral disc syndrome with incapacitating episodes which would provide for a higher rating under that formula.  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 adjudication for the neck condition.

Chronic Low Back Pain (LBP).  According to the STR and the MEB NARSUM, the CI’s back condition also began in December 2004 after the MVA, and was later exacerbated by a difficult parachute landing.  In March 2005, X-ray studies revealed a normal thoracic spine.  

At the orthopedic visit on 21 June 2005, 13 months prior to separation, the CI reported LBP which radiated into both legs.  The examiner documented an MRI report performed the day prior that revealed lumbosacral degenerative disc disease and a centrally-based, torn disc.  At the pain clinic appointment on 15 December 2005, 7 months before separation, the CI had LBP that radiated to the posterior thigh, left and right calf, and left foot.  He stated that the back pain worsened “with back flexion, twisting movements, morning stiffness, cold and rainy weather, and prolonged sitting/standing.”  While the examiner noted tenderness, and that pain started at 5 degrees of both flexion and extension during ROM tests, there were no recorded endpoint measurements.  

During the 20 January 2006 MEB PT study, thoracolumbar ROM, in degrees, was recorded as:   forward flexion to 40 (normal 90), extension to 15 (normal 30), right and left lateral flexion to 20 (normal 30) and right and left rotation to 30 (normal) with a combined ROM of 155 degrees (normal 240).  At the 13 March 2006 MEB NARSUM, 4 months prior to separation, the CI continued to endorse back pain and the examiner repeated the January PT ROM measurements.  A permanent physical profile was issued in March 2006 and included the ability and authorization to perform unlimited biking.  There was no C&P evaluation proximate to separation.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 0%, coded 5237 (lumbosacral strain), citing painful motion, no muscle spasm, no tenderness, and normal neurological examination.  Members extensively deliberated over the CI’s degree of physical impairment in light of having a single ROM measurement with numerical parameters and its association with the totality of the treatment record.  The panel considered the possibility of the neck and back flexion measurements being documented in reverse and thus casting doubt on their accuracy.  Although panel members eventually ruled out this possibility, it still left a small degree of doubt in regards to the documented ranges.  Additionally, the panel took into account other findings, such as the CI’s ability to at least get to a point of “prolonged sitting,” as well as the ability to sit on and ride a bike as noted on his physical profile.  The panel majority noted that such activity would be inconsistent with a low back that is maximally flexed to 40 degrees, and therefore, placed minimal probative value on the single ROM measurement.  However, the panel majority agreed that a 10% rating, but no higher, was justified for documented spinal tenderness.   After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel majority recommends a disability rating of 10% for LBP condition, coded 5237. 

BOARD FINDINGS:  In the matter of the chronic neck pain condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the chronic LBP condition, the panel majority recommends a disability rating of 10%, coded 5237 IAW VASRD §4.71a.  The single voter for dissent recommends modification to 20% for the LBP condition and elected not to submit a minority opinion.  There are no other conditions within the panel’s scope of review for consideration.  

The panel majority recommends the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Neck Pain	5299-5237	10%	
Chronic Low Back Pain	5237	10%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170305, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180006218, 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. 

Sincerely,					      
Enclosure