RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-04983
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050415

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Light Vehicle Mechanic, medically separated for “chronic subjective neck pain” and “chronic subjective back pain,” rated 10% each, with a combined disability rating of 20%.  

CI CONTENTION:  The VA gave him 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 - 20040502	VARD - 20060203	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Subjective Neck Pain	5299-5242	10%	Neck Injury C4-5,  Spine Disc Disease	5243	10%	20051108	
Chronic Subjective Back Pain	5299-5237	10%	Low Back Injury L4-5, Disc Disease	5243	10%	20051108	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Chronic Subjective Neck Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s neck condition began in 2003 after being involved in two vehicle accidents while deployed.  Cervical X-rays showed degenerative disc disease (DDD) and spinal arthritis, and an MRI on 22 March 2004 revealed neuroforaminal narrowing at C5-6 in addition to DDD and arthritis.  At a neurosurgery consult on 2 August 2004, 8 months prior to separation, the CI reported neck pain which often radiated into the shoulders.  The examiner recorded full, cervical spine range of motion (ROM) with pain at the extremes of extension; provocative testing to elicit radicular symptoms was negative (Spurling’s test).  A CT myelogram showed degenerative changes with some neuroforaminal narrowing, but without obvious spinal cord compression, and the neurosurgeon was not confident that surgery would be beneficial.  

At the 13 October 2004 MEB examination (recorded on DD Forms 2807-1 and 2808), 6 months before separation, physical findings noted neck tenderness with decreased flexion, side bending, and rotation.  The 10 December 2004 MEB NARSUM examination, 4 months prior to separation, noted CI complaints of sharp, severe neck pain.  Physical examination showed a normal gait, tenderness along the cervical spine, and a negative Spurling’s maneuver.  The upper extremities showed normal strength, sensation, and reflexes, and ROM measurements, using a goniometer, revealed cervical flexion of 10 degrees (normal 45) and combined ROM of 160 degrees (normal 340), with painful motion.  

At the 8 November 2005 VA Compensation and Pension (C&P) examination, 7 months after separation, the CI reported neck pain.  Physical examination showed cervical flexion of 45 degrees and combined ROM of 330 degrees “without any pain except at the extreme of extension.”  At a VA primary care appointment on 17 May 2006, the CI indicated he wanted to have a physical to return to the Reserves or the National Guard.  He stated that he had five physical tests within 1 month that put a lot of stress on his back, which was then profiled.  However, he reported no current problems and felt he could perform “whatever duty” he was called to do.  On physical examination, the neck was supple with full ROM.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the neck condition 10%, analogously coded 5299-5242 (degenerative arthritis of the spine), citing cervical ROM limited by pain.  The VA also rated the neck condition 10%, but coded 5243 (intervertebral disc syndrome (IVDS)), based on the C&P examination, citing disc disease and painful motion.  Members reviewed the disparate ROM values recorded at the MEB and VA examinations.  The MEB NARSUM was the most proximate examination to separation, however, there was no other documentation in record of such restricted cervical ROM before or after separation.  In accordance with VASRD §4.7 (higher of two evaluations), “where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating.  Otherwise, the lower rating will be assigned.” The panel concluded the CI’s disability due to the neck condition was more closely approximated by a 10% rating rather than a 30%.  There was no evidence of IVDS which resulted in incapacitating episodes requiring physician-prescribed bed rest to warrant consideration of rating under that formula.  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 neck condition.  

Chronic Subjective Back Pain.  According to the STR and MEB NARSUM, the CI’s back condition began in 2003 after the aforementioned vehicle accidents.  Lumbar X-rays showed DDD and spinal arthritis, and an MRI in February 2004 revealed a transitional vertebra (normal variant) with DDD but without nerve root displacement.  At the August 2004 neurosurgery evaluation, the CI reported back pain which occasionally radiated into the legs, but denied neurologic symptoms, weakness or change in gait.  The provider noted a normal gait, full thoracolumbar ROM, and normal lower extremity strength, sensation, and reflexes.    

The MEB NARSUM examination noted complaints of back pain which prevented the CI from doing his job.  Physical examination showed a normal gait and tenderness along the mid to low thoracic spine.  The lower extremities showed normal strength, sensory, and reflexes, and goniometric ROM measurements revealed flexion of 80 degrees (normal 90) and combined ROM of 205 degrees (normal 240), with painful motion.  

At the C&P examination, the CI reported recurrent low back pain with heavy lifting and with sitting more than 30 to 40 minutes.  Physical examination showed normal lower extremity strength, sensation and reflexes.  Measured ROM revealed flexion of 90 degrees and combined ROM of 240 degrees, with pain noted only at the extremes of rotation; X-rays showed disc space narrowing from L5 to S1.  At the May 2006 VA primary care visit mentioned above, physical examination showed full back ROM without tenderness.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, analogously coded 5299-5237 (lumbar strain), citing thoracolumbar ROM limited by pain.  The VA also rated the back condition 10%, but coded 5243, based on the C&P examination, citing disc disease and painful motion.  Members agreed that a 10% rating, but no higher, was justified based on limitation of flexion (greater than 60 degrees but not greater than 85 degrees) as reported on the MEB NARSUM examination.  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.  Although the CI had IVDS and reported occasional radiating pain into his legs prior to separation, there was no evidence of incapacitating episodes requiring physician-prescribed bed rest to warrant consideration of rating under that formula.  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.  

BOARD FINDINGS:  In the matter of the neck condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the back 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.  Therefore, the panel recommends no modification or re-characterization of the CI’s disability and separation determination.  

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Dear XXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	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.

Sincerely,					      
Enclosure