RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03300
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20071130

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E-5, Financial Management Technician, medically separated for “chronic neck pain” and “chronic [right] hip pain,” rated 10% each, with a combined disability rating of 20%.  

CI CONTENTION:  “DoD records clearly indicate and support eligibility for a higher rating.”  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 - 20070814	VARD - 20080404	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Neck Pain	5235	10%	Cervical Spine Fracture	5235	20%	20070828	
Chronic Right Hip Pain	5099-5003	10%	S/P Pelvic Fracture, Right Hip Pain	5299-5255	10%	20070828	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Chronic Neck Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s neck condition began on 9 April 2005 after he was hit by a truck while riding a motorcycle.  He was treated with halo (external stabilization) for 6 months for an odontoid fracture.  X-rays in October 2006 documented mild deformity of the odontoid (C2) and disc degeneration at C4-C6.  

The 16 May 2007 MEB NARSUM examination, 5 months prior to separation, noted complaints of chronic neck pain.  Physical examination showed no cervical bony tenderness.  The MEB range of motion (ROM) study was conducted by physical therapy (PT) on 22 June 2007 and measurements were taken with an inclinometer, except for the rotation measurements which were taken with a goniometer.  Flexion was 35 degrees (normal 45) and combined ROM was 230 degrees (normal 340).  There was tenderness and guarding with abnormal spinal contour.  On 3 August 2007, orthopedics informed the PT evaluator that there was “no mechanical block, limited ROM was due to pain.”  In an STR entry on 3 August 2007, PT restated the same ROM measurements noted above, with changed comments indicating painful limitation of motion.  

At the 28 August 2007 VA Compensation and Pension (C&P) examination, 3 months before separation, the CI reported neck pain, stiffness and weakness.  The examiner noted a normal posture and gait.  There was cervical tenderness and ROM using a goniometer was painful with flexion of 30 degrees and combined ROM of 145 degrees.  There was no additional limitation after repetition.  X-rays showed mild deformity of C2 and mild anterior wedging of C5.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the neck condition 10%, coded 5235 (vertebral fracture or dislocation), citing ROM limited by pain, with localized tenderness.  The VA rated the neck condition 20%, also coded 5235, based on the C&P examination, citing forward flexion of the cervical spine greater than 15 degrees but not greater than 30 degrees or combined ROM not greater than 170 degrees.  

In assigning probative value to these somewhat conflicting examinations, the panel noted that the MEB PT ROM evaluation was more remote from separation and used an inclinometer for most of the measurements.  However, the panel noted that the guarding with abnormal spinal contour described in the examination supported a 20% rating.  The VA examination was closest to, and prior to, separation, used a goniometer (IAW VASRD §4.46 - accurate measurement) and was consistent with other proximate (pre-separation) examinations and the underlying pathology.  Therefore, based on all the evidence and associated conclusions just elaborated, panel members agreed that preponderant probative value should be assigned to the pre-separation VA examination.  

The panel agreed that a 20% rating, but no higher, was justified for limitation of flexion (greater than 15 degrees but not greater than 30 degrees) and/or combined ROM (not greater than 170 degrees), as reported on the VA examination.  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 recommends a disability rating of 20% for the neck condition, coded 5235.  

Chronic Right Hip Pain.  According to the STR and MEB NARSUM, the CI’s hip condition began on 9 April 2005 in the above mentioned motorcycle accident.  He had a pelvic ring injury (pubic diastasis with bilateral sacroiliac joint disruption) treated the following day by open reduction and internal fixation with plate and screw.  

The MEB NARSUM examination noted complaints of right hip pain.  Physical examination showed a well healed incision in the pelvic area.  There was right sacroiliac joint tenderness.  The pelvis was solid to rock and the groin and symphysis were not tender.  Pelvic X-rays showed retained hardware with right sacroiliac joint sclerosis suggesting healing or degenerative changes.  The NARSUM (and MEB) diagnosis was “chronic right hip pain.”  The 22 June 2007 PT ROM study documented painful right hip ROM with flexion to 80 degrees (normal 125), extension to 9 degrees (normal 30), external rotation to 5 degrees (normal 60) and abduction to 20 degrees (normal 45).  

At the C&P examination, the CI reported pain in the pelvis traveling to the right leg, foot and toes.  He was limited in weight bearing, impact activities and sitting or standing for long periods.  The examiner found a normal posture and gait with a well healed right lateral pelvic scar.  There was hip tenderness and guarding of movement.  Right hip ROM was painful with flexion of 50 degrees and extension of 15 degrees.  Although the examiner indicated that the right hip joint function was additionally limited following repetitive use due to pain, weakness and lack of endurance, the limitation was 0 degrees.  Hip X-rays were normal.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right hip condition 10%, coded analogously as 5099-5003 (degenerative arthritis), citing the US Army Physical Disability Agency pain policy.  The VA rated the hip condition 10%, coded analogously to 5255 (femur, impairment of), based on the C&P examination, citing slight hip or knee disability.  

The panel considered the tenants of VASRD §4.66 (sacroiliac joint) and §4.67 (pelvic bones) and considered an alternative rating analogous to 5236 (sacroiliac injury and weakness).  However, the unfitting aspect of the CI’s injury was pain in the right hip and there was higher-level lumbar pathology that did not allow for comprehensive spine rating for the pelvic injury analogous to the 5236 spine coding without including thoracolumbar-specific pathology that was not related to an unfitting PEB condition.  

There was no compensable limitation of hip motion under codes 5250 thru 5253.  However, the PT and VA examinations documented sufficient evidence of painful motion causing functional loss (based on §4.59, §4.40 and §4.45) to warrant a 10% rating.  The PEB’s coding of 5099-5003 was supportable given the sacroiliac degeneration and painful motion, and alternative coding analogous to 5255, similar to the VA, would offer no benefit to the CI.  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 right hip condition.  

BOARD FINDINGS:  In the matter of the neck condition, the panel recommends a disability rating of 20%, coded 5235 IAW VASRD §4.71a.  In the matter of the hip condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  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 Neck Pain	5235	20%	
Chronic Right Hip Pain	5099-5003	10%	
COMBINED	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170509, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR20180008818, 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 minus the amount of severance pay you were previously paid at 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