RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-04054
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20060618

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E7, Information Systems Operations-Analyst, medically separated for “low back pain” and “neck pain,” rated 10% and 0%, respectively, with a combined disability rating of 10%.  

CI CONTENTION:  “After my discharge I continued to experience pain in my back and neck.”  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 - 20060302	VARD - 20070502	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5299-5242	10%	Degenerative Disc Disease L4-5 and L5-S1 and Degenerative Joint Disease	5242	20%	20060317	
Chronic Neck Pain	5299-5242	0%	Degenerative Disc Disease C5-6	5242	0%	20060317	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s back condition was being managed for many years with steroid injections, medications and physical therapy until February 2005 when she was involved in a motor vehicle accident.  An MRI revealed disc bulges at L4-L5 and L5-S1, consistent with the previous MRI.  She was not a surgical candidate and was unresponsive to conservative therapy.  She also received injections without relief of her symptoms and chiropractic treatments.  

The 6 December 2005 MEB NARSUM examination, 6 months prior to separation, noted complaints of daily, 8/10 lower back pain.   The pain was aggravated with prolonged standing, sitting, bending or squatting.  Physical examination showed tenderness.  Painful range of motion (ROM) was noted with forward flexion of 45 degrees (normal 90) and combined ROM of 155 degrees (normal 240), after repetition.  The 6 February 2006 primary care evaluation showed an antalgic gait and lumbosacral muscle spasms.  

At the 17 March 2006 VA Compensation and Pension (C&P) examination, 3 months before separation, the CI reported lower back stiffness in the morning and with prolonged sitting, standing or exposure to cold.  She reported weakness with lifting, prolonged sitting, standing or walking.  The 8/10 pain occurred constantly and traveled to the back of the legs.  However, she could function with medication.  She related incapacitating episodes as often as two times per month, lasting 2 days.  Over the past year she had 24 incidents of incapacitation for a total of 48 days.  The condition resulted in 3 times lost from work per month.  Physical examination showed normal posture and gait.  The ROM evaluation showed flexion of 90 degrees and combined ROM of 240 degrees.  There was no muscle spasms, tenderness or ankyloses of the spine.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, analogously coded 5242 (degenerative arthritis of the spine), citing painful motion.  The VA rated the back condition 20%, coded 5242, based on the C&P examination, citing limitation of forward flexion.  

The panel noted the NARSUM showed thoracolumbar forward flexion limited to 45 degrees.    However, the panel placed higher probative value on the totality of the evidence and VA examination proximate to separation which demonstrated painful motion.  The panel agreed a 10% rating was justified for the presence of painful motion.  The evidence did not support a rating for 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 evidence of incapacitating episodes resulting from intervertebral disc syndrome (IVDS); however, it did not total at least 2 weeks to warrant consideration of a 20% or higher rating under the alternate VASRD formula for that condition.  After due deliberation, considering all 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 back condition.  

Chronic Neck Pain.  According to the STR and MEB NARSUM, the CI’s back condition was being managed for many years with steroid injections, medications, and physical therapy until February 2005 when she was involved in a motor vehicle accident.  A cervical MRI revealed disc bulges without significant narrowing.  She was not a surgical candidate and was unresponsive to conservative therapy.  

At the 16 December 2005 occupational therapy evaluation, the CI reported neck and right shoulder pain with bilateral upper extremity numbness.  Physical examination showed cervical flexion to 40 degrees (normal 45) and decreased right grip strength relative to the left.  However, electrodiagnostic testing was normal for the right upper and lower extremities. The MEB NARSUM examination noted complaints of daily, 8/10 neck pain, which was aggravated with prolonged standing, sitting, bending or squatting.  Physical examination showed painful flexion of 40 degrees and combined ROM of 185 degrees (normal 340).  

At the C&P examination, 3 months before separation, the CI reported neck pain, stiffness and weakness in the morning and with prolonged use or bending of the neck.  The 8/10 pain occurred constantly and was elicited by physical activity and stress, but she could function with medication.  The condition did not cause incapacitation, although it did result in 2 days lost from work per month.  Physical examination revealed no evidence of muscle spasm, tenderness or anklyosis of the spine.  The ROM evaluation showed painful flexion of 45 degrees and combined ROM of 340 degrees.  Although the examiner indicated the joint function of the spine was additionally limited by pain after repetitive use, the additional limitation was not specified.  The neck was not additionally limited by fatigue, weakness, lack of endurance or incoordination.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the neck condition 0%, analogously coded as 5242, citing painful motion.  The VA rated the neck condition 0%, coded 5242, based on the C&P examination, citing forward flexion of the cervical spine greater than 40 degrees.  Although there was insufficient limitation of motion to support a 10% rating, the panel agreed a 10% rating was justified for the presence of painful motion.  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 evidence of IVDS which resulted in incapacitating episodes requiring physician-prescribed bed rest to warrant consideration of rating under the alternate VASRD formula for that condition.  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 neck condition, coded 5242.  

BOARD FINDINGS:  In the matter of the back condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the neck condition, the panel recommends a disability rating of 10%, analogously coded 5299-5242 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 Low Back Pain 	5299-5242	10%	
Chronic Neck Pain 	5299-5242	10%	
COMBINED	20%	

AR20190002413, 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.