XXXXXXXXXX. 

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.

RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX.	CASE:  PD-2017-05150
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20060712

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6, Infantryman, medically separated for “chronic neck pain” and “chronic lower back pain,” rated 10% each, with a combined disability rating of 20%.

CI CONTENTION:  The VA gave the CI a higher rating and he requested review of additional conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB).  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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the 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 – 20060505	VARD – NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Neck Pain	5237	10%	No VA Examination Proximate to Separation in Evidence	
Chronic Lower Back Pain	5237	10%		
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Neck Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI had a long history of neck pain that significantly increased in 2005.  An MRI in October 2005 showed disc bulges at C3-4 and C5-6 indenting the thecal sac.  Electrodiagnostic studies were normal.  During the 17 March 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 4 months prior to separation, physical examination revealed cervical spine tenderness and muscle spasms. The 28 March 2006 MEB NARSUM examination noted complaints of constant neck pain that radiated into the left arm.  Physical examination showed a normal gait, but there was spinal tenderness and muscle spasms.  The goniometric range of motion study showed flexion of 35 degrees (normal 45) and combined ROM of 215 degrees (normal 340) with painful motion.  There was no VA examination proximate to separation in evidence, although the panel noted the 18 October 2007 VA examination of the neck was rated at 10% (5243-5010 for painful motion).  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the neck condition 10%, coded 5237 (cervical spine strain), citing cervical ROM limited by pain with localized tenderness.  The panel agreed that a 10% rating, but no higher, was justified for limitation of flexion (greater than 30 degrees but not greater than 40 degrees) and/or combined ROM (greater than 170 degrees but not greater than 335 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.  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 concluded there was insufficient cause to recommend a change in the PEB adjudication for the neck condition.  

Chronic Lower Back Pain.  According to the STR and MEB NARSUM, the CI had a long history of low back pain that significantly increased in 2005.  An MRI in January 2006 was normal.  During the MEB examination, 4 months prior to separation, the physical examination revealed tenderness and decreased ROM.  The MEB NARSUM examination, 4 months prior to separation, noted complaints of constant low back pain.  Physical examination showed a normal gait, but there was tenderness and muscle spasms.  The goniometric ROM evaluation showed flexion of 85 degrees (normal 90) and combined ROM of 230 degrees (normal 240) with painful motion.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, coded 5237 (lumbar spine strain), citing thoracolumbar ROM limited by pain with localized tenderness.  The panel agreed that a 10% rating, but no higher, was justified for limitation of flexion (greater than 60 degrees but not greater than 85 degrees) or combined ROM (greater than 120 degrees but not greater than 235 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.  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 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.