RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXXXX	CASE: PD-2017-04265
BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20061222

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Petroleum Supply Specialist, medically separated for “chronic neck pain” and “chronic low back pain,” rated 10% each, with a combined disability rating of 20%.

CI CONTENTION:  No specific contention was made.  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 - 20061128	VARD - 20070516	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Neck Pain	5237	10%	Degenerative Disk Disease Cervical Spine	5242	20%	20070423	
Chronic Low Back Pain	5237	10%	Degenerative Disk Disease, Lumbosacral Spine	5242	20%	20070423	
COMBINED RATING: 20%	COMBINED RATING OF ALL VA CONDITIONS: 70%	

ANALYSIS SUMMARY:

Chronic Neck Pain. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s neck condition began in September 2005 after physical training. MRI performed on 27 February 2006 showed small paracentral disc protrusions at C3-C4 and C4-5 with no evidence of neural impingement, and mild straightening of the normal cervical spine lordotic curvature.

The 16 October 2006 MEB NARSUM examination, 2 months prior to separation, noted complaints of chronic neck pain with radiation that increased with activity. The physical examination repeated the 6 July 2006 physical therapy (PT) examination, 6 months prior to separation, where the CI reported burning neck pain that radiated. Cervical spine range of motion (ROM) measurements were flexion of 25 degrees (normal 45) and combined ROM of 180 degrees (normal 340) with all motion limited by pain. The examiner noted the CI was grimacing during all testing. Manual muscle tests of the cervical spine showed 3-/5 in all planes. Compression and distraction tests of the cervical spine were negative, but caused increased pain and increased muscles spasm at the upper trapezius bilaterally. Posture showed significantly decreased cervical lordosis.

At the 14 March 2007 physical medicine clinic (PMC) appointment, 3 months after separation, the examiner noted cervical spine ROM was markedly limited in all planes of motion and painful. There was minimal tenderness over the right side of the neck and also right trapezius area. At the 12 April 2007 PMC appointment the examiner found cervical ROM was restricted by 75% in all planes of movement. The examiner noted tenderness to the bilateral upper trapezius muscles and posterior cervical musculature.

At the 23 April 2007 VA Compensation and Pension (C&P) examination, 4 months after separation, the CI reported mid-cervical spine pain with right arm radiation. Cervical ROM was flexion of 30 degrees and combined ROM of 120 degrees, with all motion limited by pain. The examiner found that repetitive exercises reduced forward flexion to 20 degrees due to pain and lack of endurance.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the neck condition 10%, coded 5237 (cervical strain), citing passive ROM accompanied by pain, tenderness and normal gait. The VA rated the neck condition 20%, coded 5242 (degenerative arthritis of the spine), based on the C&P examination, citing forward flexion of the cervical spine greater than 15 degrees but not greater than 30 degrees; or, the combined ROM of the cervical spine is not greater than 170 degrees. The panel adjudged that the PMC spine motion evaluation was not IAW VASRD §4.46 (accurate measurement), and was an outlier indicating significantly worse ROMs than the earlier PT and later C&P ROMs, and therefore had lower probative value for rating at separation. Additionally VASRD spine ratings are based on active rather than passive ROMs. 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) as reported on the NARSUM and VA examinations. There was no documentation of intervertebral disc syndrome (IVDS) 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 20% for the neck condition, coded 5237.

Chronic Low Back Pain. According to the STR and MEB NARSUM, the CI’s back condition began in August 2006 after insidious onset without specific history of trauma or injury. A September 2006 MRI, showed degenerative disc disease at L5 to S1 and a disc bulge with an annulus tear at L5 to S1 with a minimal eccentric disc bulge versus a minimal herniation at L4 to L5. The CI underwent a series of five epidural steroid injections; however, there was no change in his condition.  An evaluation by neurosurgery deemed him to be a nonsurgical candidate.

The 16 October 2006 MEB NARSUM examination, 2 months prior to separation, noted complaints of chronic back pain. The physical examination repeated the 6 July 2006 PT examination where the CI reported back pain worsened by repetitive bending or prolonged sitting. Gait was slow without significant deficits. Thoracolumbar ROM measurements were flexion of 60 degrees (normal 90) and combined ROM of 160 degrees (normal 240), with painful motion. Lumbar pain increased with palpation and increased muscle spasm in the upper trapezius bilaterally. Manual

muscle tests of the lumbar spine showed 3+/5 in all planes. Posture showed mild scoliosis and decreased lumbar curve.

At the 14 March 2007 PMC appointment the examiner noted the lumbosacral spine limited flexion to 10 inches from finger to the ground (approximately 70-80 degrees) and was painful. Extension was 15 degrees and painful. There was tenderness present over the paraspinal areas, right more than the left, associated with spasm and tightness. At the 12 April 2007 PMC appointment the examiner found the CI was “restricted in forward bending by 75% (approximately 15 degrees) with increased low back pain. Backward bending is restricted by 25%. Bilateral rotation and side bending were restricted by 75% with increased low back pain.” Repetitive flexion increased his symptoms. The examiner noted the CI had forward head posture, decreased lumbar lordosis and increased thoracic kyphosis and tenderness to the lumbar paraspinal.

At the C&P examination the CI reported pain with flare-ups about once or twice a month and pain that radiated down into the right thigh. The examiner noted he could easily walk 1 to 2 miles and on examination had a normal gait. The tips of the lower lumbar vertebral bodies were tender to deep palpation but there was no tenderness, in the costovertebral angles and no presacral edema. Physical examination showed thoracolumbar ROM measurements flexion 70 degrees and combined ROM of 110 degrees.  Repetitive exercises reduced forward flexion to 60
.degrees due to pain and lack of endurance.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the back condition 10%, coded 5237 (lumbosacral strain), citing passive ROM accompanied by pain, tenderness and normal gait. The VA rated the back condition 20%, coded 5242 (degenerative arthritis of the spine), based on the C&P examination, citing forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or, the combined range of motion of the ,thoracolumbar spine is not greater than 120 degrees. Similar to the neck analysis above, the panel adjudged that the PMC spine motion evaluations were not IAW VASRD §4.46 (accurate measurement), and were outliers indicating significantly better and worse ROMs than the earlier PT and later C&P ROMs, and therefore had lower probative value for rating at separation. Additionally VASRD spine ratings are also based on active rather than passive ROMs. The panel agreed that a 20% rating, but no higher, was justified for limitation of flexion (greater than 30 degrees but not greater than 60 degrees), as reported on the MEB NARSUM and VA examinations. There was no documentation of IVDS 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 20% for the back condition, coded 5237.

BOARD FINDINGS: In the matter of the neck condition, the panel recommends a disability rating of 20%, coded 5237 IAW VASRD §4.71a. In the matter of the back condition, the panel recommends a disability rating of 20%, coded 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; 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	5237	20%	
Chronic Back Pain	5237	20%	
	COMBINED	40%	

AR20190012178, XXXXXXXXXXXXXXXXXXXX 

Dear XXXXXXXXXXXXXXX

I accept the recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) to re-characterize your separation as a permanent disability retirement with the combined disability rating of 40% 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 permanent 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), XXXXXXXXXXXXXXXXXXXXXXXXXXXX.

	A copy of this decision has also been provided to the Department of Veterans Affairs.