RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03435
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20061218

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E-4, Parachute Rigger, medically separated for “chronic diarrhea and abdominal pain,” “chronic low back pain,” “chronic neck pain” and “chronic daily tension headaches,” each rated 0%, with a combined disability rating of 0%. 

CI CONTENTION:  Examined by the VA before separation and given a higher rating by them.  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 - 20060828	VARD - 20070306	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Diarrhea and Abdominal Pain	7399-7319	0%	Residuals from Resection of Phlegmonous Right Colitis and Appendicitis	7328-7346	10% 	20061010 	
Chronic Low Back Pain	5237	0%	Chronic Lumbosacral Strain	5237	20%	20061010	
Chronic Neck Pain	5237	0%	Chronic Cervical Strain	5243	20%	20061010	
Chronic Daily Tension Headaches	5399-5323	0%	Tension Headaches	8199-8100	0%	20061010	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Chronic Diarrhea and Abdominal Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s chronic diarrhea and abdominal pain began in May 2005.  The CI was ultimately diagnosed with appendicitis that had spread to involve part of the small intestine that also had to be removed during surgery on 14 June 2005.  The CI recovered but continued to have recurring 2-6/10 right lower quadrant abdominal pain and developed chronic diarrhea 5-8 times daily due to loss of his ileocecal valve from surgery.  Treatment with anti-diarrheal medications did not improve his symptoms.  The 2 May 2006 MEB NARSUM examination, 8 months prior to separation, noted complaints of daily diarrhea as noted above.  Physical examination showed a normal abdomen and no tenderness of the right lower quadrant.  

At the 10 October 2006 VA Compensation and Pension (C&P) examination, 2 months before separation, the CI reported diarrhea 8 times daily with a pulling pain in the right lower quadrant.  Physical examination showed abdominal tenderness of the right lower quadrant.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic diarrhea and abdominal pain 0%, analogously coded as 7319 (irritable colon syndrome).  The VA rated the chronic diarrhea and abdominal pain 10%, analogously coded 7328-7346 (resection of small intestine and hiatal hernia) based on the C&P examination, citing differing sites of pathology producing a common disability picture.  

The panel agreed that a 10% rating, but no higher, was justified for frequent episodes of bowel disturbance with abdominal distress analogously coded 7399-7319.  Though the CI had diarrhea 5-8 times per day, there was no evidence that he was in near constant distress and was able to function relatively normally between trips to the toilet, thus there was no diarrhea, or alternating diarrhea and constipation, with more or less constant abdominal distress to justify the next higher 30% rating on this basis.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the chronic diarrhea and abdominal pain, analogously coded 7399-7319.  

Chronic Low Back Pain.  According to the STR and MEB NARSUM, the CI’s chronic back condition began in March 2005 after a hard parachute landing.  He was not a surgical candidate and despite conservative treatment his symptoms persisted.  During the MEB NARSUM examination the CI complained of daily 5/10 low back pain with occasional spasms.  Physical examination showed negative straight leg raise and normal reflexes.  There was moderate pain with extension, rotation and side bending. The 9 May 2006 physical therapy (PT) range of motion (ROM) evaluation, 8 months prior to separation, showed flexion of 75 degrees (normal 90), with pain, and combined ROM of 155 degrees (normal 240).  

At the C&P examination the CI reported chronic 7/10 low back pain.  Physical examination showed no muscle spasm or tenderness and straight leg raise testing was positive.  The ROM evaluation showed flexion of 40 degrees and combined ROM of 120 degrees with pain in all planes of movement.  The ROM was not additionally limited by repetitive use and there was no evidence of intervertebral disc syndrome (IVDS).  

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.  The VA rated the back condition 20%, coded 5237, based on the C&P examination, citing limitation of forward flexion.  

The panel majority placed greater probative value on the PT examination and agreed that a 10% rating, but no higher, was justified for limitation of flexion greater than 60 degrees but not greater than 85 degrees.  There was no documentation of IVDS 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 majority recommends a disability rating of 10% for the back condition, coded 5237.  

Chronic Neck Pain.  According to the STR and MEB NARSUM, the CI’s neck condition began in March 2005 after a hard parachute landing.  He was not a surgical candidate and despite conservative treatment his symptoms persisted.  The MEB NARSUM examination noted complaints of chronic neck pain.  Physical examination showed mild pain at the extremes of all movements.  The CI was neurologically intact and had normal strength.  The PT ROM study of the neck showed flexion of 45 degrees (normal) and combined cervical ROM of 250 degrees (normal 340), with pain in all directions.  

At the C&P examination there was no evidence of radiating pain on movement, tenderness or muscle spasm.  The ROM study of the neck revealed flexion of 30 degrees and combined ROM of 140 degrees, with pain.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the neck condition 0%, coded 5237, citing painful motion.  The VA rated the chronic neck condition 20%, coded 5243 (IVDS), based on the C&P examination, citing limitation of combined ROM.  

The panel majority placed greater probative value on the PT examination and agreed that a 10% rating, but no higher, was justified for forward flexion of the cervical spine greater than 30 degrees but not greater than 40 degrees.  There was no documentation of IVDS 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 majority recommends a disability rating of 10% for the neck condition, coded 5237.  

Chronic Daily Tension Headaches.  According to the STR and MEB NARSUM, the CI’s chronic daily tension headaches began in June 2005.  He was treated with various medications, including those for migraine headaches, with minimal or inconsistent relief.  On one occasion he complained of light sensitivity and nausea.  At a 20 June 2006 neurology evaluation, 6 months prior to separation, the CI complained of debilitating headaches 1 or 2 times a week.  Physical examination was normal and the examiner noted that the frequency of the headaches had decreased, but still concluded the CI had moderate to severe tension type headaches that were impacting work performance.  

At the C&P examination the CI reported an average of 3 headaches per day lasting 2 hours and limiting physical activities.  Physical examination was normal.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the headaches 0%, analogously coded as 5323 (muscle group XXIII, movements of the head).  The VA also rated the headaches 0%, analogously coded 8100 (migraine), based on the C&P examination, citing no evidence of prostrating attacks.  

Although the panel noted the CI had almost daily tension headaches, after reviewing the evidence, the panel agreed there was no clear evidence of characteristic prostrating attacks averaging one in 2 months over the last several months to justify a 10% rating under code 8100.  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 headaches.  

Contended PEB Conditions:  Anxiety Disorder, Depression, GERD and Hearing Loss.  The panel’s main charge is to assess the fairness of the PEB determinations that the contended conditions were not unfitting.  None of the conditions were implicated in the commander’s statement or judged to fail retention standards, and only the hearing loss was profiled.  There was no performance-based evidence from the record that any of the conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determinations for any of the contended conditions, so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the chronic diarrhea and abdominal pain, the panel recommends a disability rating of 10%, analogously coded 7399-7319 IAW VASRD §4.114.  In the matter of the back condition, the panel majority recommends a disability rating of 10%, coded 5237 IAW VASRD §4.71a.  In the matter of the neck condition, the panel majority recommends a disability rating of 10%, coded 5237 IAW VASRD §4.71a.  In the matter of the headaches and IAW VASRD §4.124a, the panel recommends no change in the PEB adjudication.  In the matter of the contended anxiety disorder, depression, GERD and hearing loss, the panel recommends no change from the PEB determinations as not unfitting.  The single voter for dissent recommends re-characterization to 40% and submitted the appended minority opinion.  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 Diarrhea and Abdominal Pain	7399-7319	10%	
Chronic Low Back Pain	5237	10%	
Chronic Neck Pain	5237	10%	
Chronic Daily Tension Headaches	5399-5323	0%	
COMBINED	30%	

Minority Opinion

The minority voter noted that the C&P examination, 2 months prior to separation, was more detailed and reported ROMs performed after repetitive motion and were more reflective of the CI’s condition at time of separation.  The minority voter concludes that both the cervical and thoracolumbar ROMs justified a rating of 20% each resulting in an overall combined rating of 40% for the CI.  

The minority 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 Diarrhea and Abdominal Pain	7399-7319	10%	
Chronic Low Back Pain	5237	20%	
Chronic Neck Pain	5237	20%	
Chronic Daily Tension Headaches	5399-5323	0%	
COMBINED	40%	

AR20180015343, 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.