RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:XXXXXXXXXXXXXXX
BRANCH OF SERVICE: ARMY

            CASE: PD-2017-05611 SEPARATION DATE: 20080514

SUMMARY OF CASE: Data extracted from the available evidence of record reflect s this covered individual (Cl) was an active duty E4, Petro leum Supply Specialist, medicall y separated for "chronic neck" and " chronic thoracic and lumbar pain," each rated 10%, with a combined disability rating of 20%.

Cl CONTENTION: "Disabi lity has worsen[ed] ." 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 u nfi tt ing for continued military service, and when specifically requested by the Cl, those conditions identified by the Medical Evaluation Board (M EB), but det ermined 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 app lication , may remain eligible for future consideration by the Board for Correction of Milit ary Records. The panel' s authority is limit ed to assessing the fairness and accuracy of PEB rat ing determinations and recommend ing corrections when appropriate. The panel gives consideration to VA evidence , part icular ly within 12 mont hs of separat ion, but only to the extent that it reasonab ly re fl ects the severity of disability at the time of separation.

RATINGCOM PARISON:

SERVICE PEB • 20080213	VARD-NA	
Condition	Code	Ratine	Condition	I	Code	I  Ratine  I	Exam	
Chronic Neck Pain	5299-5237	10%	No VA Examination Proximate to Separation in Evide nce	
Chr onic Th orac ic and Lumbar Pain	5237	10%		
COMBINED RATING: 20%	COMBINED RATING OF ALL VA CONDITIONS: NA	

ANALYSIS SUM M ARY:

Chronic Neck Pain. According to the service t reatment record (STR) and MEB narra tive summary (NARSUM), the Cl inj ured himself in April 2006 after jumping out of a truck and landing awkwardly. Initially the Cl' s on ly complaints were lower back pain, but the pain escalated by July 2006 to include neck pain. X-rays of the cervical spine on 18 July 2006 were normal. M RI studies on 9 May 2007 showed mild dextrosco liosis which may havebeen positiona l or rela t ed to muscle spasms, but were otherwise unremarkable.

At the 16 July 2007 neurosurgery clinic appointment , 10 months prior to  separation , the Cl repo rted neck and lower back pain. The Cl de nied any relief from chiropractic care, physical therapy (PT) or medications. On examination the Cl was in no acute distress and there was " fu ll" range of motion (ROM) of the cervical spine. Gait was normal and motor, sensory and reflexes were normal.  The examiner stated the cervical MRI did not show any pathology to explain the Cl' s neck pain or symptoms.

The 13 November 2007 MEB NARSUM examination, 6 months prior to separation, did not provide a physical examination of the cervical spine. Gait and station were non-focal. The examiner stated the initial complaints were of the lower back but progressed to include the thoracic and cervical spine as well, noting “objective evidence for injury is lacking. Although inconsistent, this is not unusual.” The diagnoses were chronic cervical spine pain, chronic thoracic spine pain, and chronic lumbar spine pain. The MEB PT cervical ROM measurements on 28 January 2008, 3 months prior to separation, showed flexion of 30 degrees (normal 45) and combined ROM of 200 degrees (normal 340) after repetition, limited by pain. Note: the source flexion ROMs were 40, 35, and 30 degrees on three repeated trials. Gait was normal. The CI exhibited hypersensitivity to palpation from the occiput to T6 and along the bilateral upper trapezius.

At the 20 June 2008 VA primary care history and physical appointment, 1 month after separation, to establish care with the VA, the CI reported neck and back pain. On examination the neck was tender with painful forward flexion, none with lateral bending. There was no VA Compensation and Pension (C&P) examination proximate to separation in evidence.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the cervical spine condition 10%, analogously coded 5237 (cervical spine strain), citing forward flexion of 40 degrees. The panel noted that the MEB PT ROM examination was the single ROM evaluation proximate to separation which included goniometric measurements and repetitive motion. Although the PEB cited 40 degrees of cervical flexion, that was the highest measurement of three repetitions from the PT ROMS, and the flexion had decreased to 30 degrees following repetition. The panel considered DeLuca criteria and agreed that a 20% rating, but no higher, was justified for limitation of flexion (greater than 15 degrees but not greater than 30 degrees) following repetition as reported on the MEB PT ROM examination. 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 cervical spine condition, coded 5299-5237.

Chronic Thoracic and Lumbar Pain. According to the STR and MEB NARSUM, the CI reported he jumped out of a truck and landed awkwardly in April 2006 and within 5 days he sought treatment stating he felt a crunch in the lower back and experienced mid-back pain and pain in the lower extremities. X-rays of the thoracic spine in July 2006 were normal. Lumbar MRI on 21 March 2007 noted mild degenerative disc disease (DDD) at L5 and mild anterior annular bulge without central or lateral stenosis. At the neurosurgery clinic appointment, the CI reported lower back pain with intermittent numbness in both legs starting about 4 months after the April 2006 injury. Lumbar spine ROM was decreased on flexion secondary to pain. Gait was normal and no spasms were noted. The examiner referred to the lumbar MRI findings (see above) stating the mild DDD didn’t correlate to the degree of lower back pain or with the leg paresthesias.

The 29 October 2007 MEB physical examination (recorded on DD Forms 2807-1 and 2808), 6 months prior to separation, n showed bilateral tenderness of the paralumbar spine and left sacroiliac (SI) joint with decreased flexion of the lumbosacral spine. The 13 November 2007 MEB NARSUM examination noted complaints of continued back pain with no significant relief from PT, chiropractic care or profiling. Physical examination showed tender bilateral para-lumbar spine and left SI joint and decreased flexion of the lumbosacral spine.

The MEB PT thoracolumbar ROM measurements on 27 December 2007, 5 months prior to separation, showed flexion of 55 degrees (normal 90) and combined ROM of 175 degrees (normal 240) after repetition. The examiner indicated that “all restrictions in motion were due to the patient’s pain level and not wanting to go beyond the pain threshold.” There was localized tenderness at L2-3. There was no abnormal gait due to muscle spasm or guarding, or abnormal spinal contour. At the 20 June 2008 VA primary care history and physical appointment, the CI

reported neck and back pain. On examination the spine was tender over the mid and low back with pain on forward flexion and extension.

The panel directed attention to its rating recommendaiton based on the above evidence. The PEB rated the thoracic and lumbar pain condition 10%, coded 5237 (lumbar spine strain) , citing forward flexion of 60 degrees. The panel agreed that a 20% rating, but no higher, was just ified for lim it ation of flexion (greater than 30 degrees but not greater than 60 degrees) as reported on the MEB PT examination. There was no documentation of IVDS with incapacit ating episodes which would provide for a highe r rat ing 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 thoraco lumba r spine condition , coded 5237.

BOARD FINDINGS: In the matter of the neck condition, the panel recommends a disabi lity rating of 20%, coded 5299-5237 IAW VASRD §4.71a. In the matter of the thoracic and lumbar spine 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 Cl' s prio r dete rmination be mod ified as fo llows; and, that the discharge with severance pay be re-character ized to reflect permanent disability retirement, effective the date of medical separation:

CONDITION	VASRDCODE	PERMANENT RATING	
Chronic Neck Pain	5299-5237	20%	
Chronic Thoracic and Lumbar Pain	5237	20%	
	COMBINED	40%	

The following documentary evidence was considered:

AR20200004334,

Dear

DEPARTMENT OF THE ARMY
ARMY REVIEW BOARDS AGENCY 251 18TH STREET SOUTH, SUITE 385
ARLINGTON, VA 22202-3531

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), 1835 Army Boulevard, Bldg. 2000, JBSA, Fort Sam Houston, TX. 78234.

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