RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXX	CASE:  PD-2017-03270
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20071210

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Automation Logistics Specialist, medically separated for “chronic pain of the right upper back and scapula” with a disability rating of 0%.  

CI CONTENTION:  “…gunshot to back, shrapnel.” 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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the 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 - 20071107	VARD - 20080307	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain of the Right Upper Back and Scapula	5099-5003	0%	Shrapnel Contusion to Back	5320-5237	20%	STR	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Chronic Pain of the Right Upper Back and Scapula.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s upper back pain began in April 2004 after being struck by shrapnel while wearing body armor.   At the time of his military re-enlistment physical, an orthopedic consult was obtained and the CI’s examination was essentially normal and no physical limitations were recommended.  The physical therapy (PT) examination on 24 July 2007 noted complaints of mid to low back pain for 3 weeks due to aggravating factors of running, push-ups and sit-ups.  Thoracic spine X-rays were normal.  Physical examination showed a normal gait.  Lumbar spine active range of motion (ROM) was flexion of 90 degrees (normal), extension of 30 degrees (normal), and right and left lateral flexion of 20 degrees each (normal 30).  There was tenderness of the right rhomboid muscles.  Strength, sensation and reflexes of the lower extremities were normal, but tests to elicit radicular symptoms were positive on the right.  

A 10 August 2007 PT follow-up visit noted there was no improvement with therapy.  The CI’s ROM had decreased and his pain had increased since his initial evaluation.  Lumbar spine active ROM was flexion of 75 degrees, extension of 20 degrees and right and left lateral flexion of 15 degrees each.  At an orthopedic examination 5 days later the CI reported chronic right upper back pain that returned when doing push-ups, running, lifting or carrying a weapon.  Physical examination showed normal thoracic spinal curvature but there was tenderness along the right thoracic paraspinous region without spasm or deformity.  There was no evidence of atrophy, hypertrophy or scapular winging, and no swelling.  Thoracic spine expansion was not restricted during inspiration and exhibited normal rib motion.  

The 5 September 2007 MEB NARSUM examination, 3 months prior to separation, noted complaints of chronic right upper back and right medial scapular pain.  Physical examination showed full active ROM of the neck, back, upper extremities and lower extremities.  There was some tenderness along the right thoracic region and medial scapular border without palpable or visible spasm.  There was no palpable snap or pop with movement of the right scapulothoracic joint.  There was no evidence of muscle atrophy, hypertrophy or scapular winging and there was no palpable or visible deformities of the thoracic spinous processes or right posterior ribs.  Radiographic evaluation of the thoracic spine and scapula revealed normal alignment and no kyphosis of the thoracic spine.  There was no evidence of fractures or degenerative changes within the vertebral bodies, facet joints, ribs or scapulothoracic joints bilaterally.  Strength, sensation, and reflexes were normal throughout.  Maneuvers to elicit radicular symptoms in the upper and lower extremities were negative.  

Thoracolumbar ROM measurements performed by PT on 30 October 2007, one month prior to separation, showed flexion of 80 degrees (normal 90) and combined ROM of 215 degrees (normal 240) after repetition, with all limitation of motion due to pain.  There was tenderness of the paraspinal muscles from T10 to L2, but no abnormal gait or abnormal spinal contour noted.  There was no VA examination proximate to separation in evidence. 

Panel members agreed that the back pain and scapula pain were not separate conditions which could be reasonably justified as separately unfitting; nor would separate ratings be achievable without violation of VASRD §4.14 (avoidance of pyramiding) and accordingly, the panel considered a single rating recommendation.   The panel then directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 0%, analogously coded 5099-5003 (degenerative arthritis), citing the US Physical Disability Agency Pain Policy.  The VA rated the back condition 20%, dual coded 5320-5237 (muscle Group XX and cervical strain), based on the STR, citing forward flexion of the cervical spine greater than 15 degrees but not greater than 30 degrees, based on flexion of 25 degrees as noted on the 30 October 2007 PT examination.  

The panel agreed that a 10% rating, but no higher, was justified for limitation of flexion (greater than 60 degrees but not greater than 85 degrees) and combined ROM (greater than 120 degrees but not greater than 235 degrees) as reported on the October 2007 PT examination, the most proximate examination 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 the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the back condition, coded 5299-5237.  

BOARD FINDINGS:  In the matter of the back 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 Pain of the Right Upper Back and Scapula	5299-5237	10%	

The following documentary evidence was considered:

	
AR20190010025, XXXXXXXXXXXXX

Dear XXXXXXXXXXXXX

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.

Enclosure