RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXX	CASE: PD-2017-05834
BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20061122

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Healthcare Specialist, medically separated for “chronic neck pain” and “chronic back pain,” rated 10% each, with a combined disability rating of 20%.

CI CONTENTION: Review requested of anxiety disorder, headaches and erectile disorder/low testosterone as well as 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 - 20061109	VARD - 20070614	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Neck Pain	5237	10%	Cervical Spine Spondylosis	5243	20%	20070203	
Chronic Back Pain	5237	10%	Lumbar Spine Strain	5237	10%		
Anxiety Disorder, Not Otherwise Specified [NOS]	
Not Unfitting	PTSD	9411	10%	20070125	
Tension Headaches		Muscle Contraction Headaches	8100	0%	20070203	
Erectile Disorder		Erectile Dysfunction	7522	0%		
COMBINED RATING: 20%	COMBINED RATING OF ALL VA CONDITIONS: 50%	

ANALYSIS SUMMARY:

Chronic Neck Pain. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s neck condition began in the fall of 2003 in Iraq without specific trauma but was  likely  related  to  wearing battle gear and carrying  heavy  loads.   Radiographic  studies  in

September 2006 revealed probable degeneration of cervical spine intervertebral discs and secondary bony degenerative changes.

At the 3 October 2006 MEB orthopedic consultation, 2 months prior to separation, the examiner recorded full ROM (not quantified) with pain at the extremes of motion. Testing for possible nerve root impingement (Spurling’s test) was negative, and muscle strength was normal. The 24 October 2006 MEB NARSUM examination, 1 month before separation, noted CI complaints of continued neck pain, rated 2-3/10, with flares at 5-6/10. Physical examination showed “normal” flexion and combined ROM of 280 degrees, with tenderness.

At the 3 February 2007 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported ongoing neck pain (rated 5/10 with flares to 8-9/10) brought on by lifting or excessive motion. He was taking both over the counter (Motrin) and narcotic (Percocet) pain medication. Physical examination showed normal gait, heel-and-toe walk, strength and reflexes. Flexion was to 30 degrees (normal 45) and combined ROM was 210 degrees (normal 340), with painful motion.  Cervical spine X-rays showed early degenerative changes.

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 tenderness and pain-limited motion. The VA rated the neck condition 20%, coded 5243 (intervertebral disc syndrome (IVDS)), based on the C&P examination, citing cervical spine forward flexion greater than 15 degrees, but not greater than 30 degrees. Panel members 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 combined ROM (greater than 170 degrees but not greater than 335 degrees), as reported on the MEB orthopedic consultation and MEB NARSUM examination. More probative value was assigned to the MEB examinations as there was congruency with the overall acuity of the condition as documented in the STR, and the NARSUM examination was also one month closer to the date of separation. There was no evidence of 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 that alternate 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 Back Pain. According to the service treatment record and MEB NARSUM, the CI’s thoracic and lumbar back pain began after a motor vehicle accident in September 2001. He also experienced low back pain during his tour in Iraq, similar to his neck symptoms. There was never any associated radicular pain, tingling or bowel or bladder symptoms, and radiographic studies performed in October 2006 and February 2007 were normal. At the MEB orthopedic consult, the examiner noted diffuse lumbar spine tenderness and normal lower extremity strength. Straight leg raise testing was negative. The MEB NARSUM examination noted complaints of back pain rated at 1-2/10, with flares at 4-5/10. Physical examination showed T8 tenderness but no scoliosis or spasm. Flexion was 90 degrees (normal) and combined ROM was 220 degrees (normal 240), with pain.  There was no decrease in ROM with repetition.

At the C&P examination, the CI reported back pain (rated 4/10 with flares to 6-7/10) brought on by repetitive motion and that he took Motrin and Percocet for pain relief. Physical examination recorded “normal” ROM with painful motion.  Thoracic and lumbar spine X-rays were normal.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the back condition 10%, coded 5237, citing tenderness and pain-limited motion. The VA also rated the back condition 10%, code 5237, based on the C&P examination. The panel agreed that a 10% rating, but no higher, was justified for limitation of 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 evidence of IVDS which resulted in incapacitating episodes requiring physician-prescribed bed rest to warrant consideration of rating under that alternate 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.

Contended PEB Conditions: Anxiety Disorder, Not Otherwise Specified, Tension Headaches, and Erectile Disorder. The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting. None of the conditions were profiled or implicated in the commander’s statement, nor failed retention standards. There was no performance-based evidence from the record that any of the conditions significantly interfered with satisfactory duty performance at separation. After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions, so no additional disability ratings are recommended.

BOARD FINDINGS: In the matter of the chronic neck and back conditions and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication. In the matter of the contended anxiety disorder NOS, tension headaches and erectile disorder conditions, the panel recommends no change from the PEB determination as not unfitting. 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.

		PD-2017-05834

AR20190009697, XXXXXXXXXXXXXXXX 

Dear XXXXXXXXXXXXXXXXXXX

	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.

	PD-2017-05834