RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:
BRANCH OF SERVICE: ARMY

CASE:  PD-2017-05997
SEPARATION DATE: 20070507

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (Cl) was an active duty ES, Wheeled Vehicle Mechanic, medically separated fo r "cervica l degenerative disc disease (DOD)" and "chronic low back pain (LBP)," rate d 10% and 0%, respect ively, with a combine d di sabi lity rating of 10%.

Cl CONTENTOI N:  Review  of  all  co nd iti o n s reque sted.  The complete submi ssion 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 disabilit y ratings assigned to those conditi ons determined by the Physical Evaluation Board (PEB) to be unfitting for continued milit ary service, and when specifically requested by the Cl, those conditi ons ident ifi ed by the Medical Evaluation Board (M EB), but determined by the PEB to be not u nfi tting or no n-compe nsable. Any conditions outside the panel' s defined scope of review, and any cont ention not requested in this app lication , may remain eligib le for future conside ration by the Board for Cor rection of Military Records. The panel' s authority is limited to assessing the fairness and accuracy of PEB rati ng determinations and recommending corrections w he n appropriate. The panel gives consideration to VA evidence , particularly wit hin 12 months of separati on, but only to the extent that it reasonab ly refl ect s the severi ty of disability at the time of separation .

RATINGCOM PARISON:

SERVICE PEB • 20070419	VARD • 20080929	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Cervical ODD	5299-5242	10%	ODD Cervical Spi ne with Hern iat ion C3-4	5243	20%	20070615	
Chronic LBP	5237	0%	Lumbosacral Strain	5237	10%	20070615	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 40%	

ANALYSISSUMMARY:

Cervical DOD. According to the service treat ment record (STR) and MEB narrative summary (NARSUM), the Cl's neck conditi on began after a motor vehicle accident (M VA) in Oct ober 2005. Cervical spine X-r ays at the time showed no fracture or inst ability. A cervical M RI in December 2006 sho wed C3-4 degenerative changes with a broad based disc bulge to the right of midline wit hout spinal cord or neuroforaminal (area through which the spi nal nerves exit) compromise. Electrodiagnostic studie s also in December 2006 were negative for radiculopathy, neuropathy, myopathy, or mye lopathy . There was no surgical indicat ion . The Cl was treated conservati vely and given a profile.

The 7 February 2007 MEB physical therapy (PT) examination, 3 months prior to separation , no t ed complaints of neck pain. Physical examination showed no abnorma l gait due to muscle spasm or guarding. Spinal contour was normal. Repetitive cervical spine fl exion was 45 degrees (normal ) and combined range of motion (ROM ) was 210 degrees (nor mal 340) . Painfu l motion was elicited . The 12 March 2007 MEB NARSUM, 2 months prior to separatio n, noted complaints of

neck pain. Physical examination showed neck tenderness without muscle atrophy. Neck ROM was performed during the aforementioned MEB PT examination. Bilateral upper extremity motor strength and deep tendon reflexes were normal. The CI was able to toe-and heel walk.

At the 15 June 2007 VA Compensation and Pension (C&P) examination, one month after separation, the CI reported neck pain without radiation to the upper extremities. He reported a period of incapacitation of 3 to 4 days in the last year and he could not drive. Physical examination showed normal gait and posture. The upper spinal contour was flat with prominent C6-7 tenderness. When observed during the examination the neck was freely mobile and normal in appearance. Neck flexion was 40 degrees and combined ROM was 300 degrees with painful motion. There was no additional ROM loss following repetitive motion.

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 ROM limited by pain. The VA rated the neck condition 20%, coded 5243 (intervertebral disc syndrome (IVDS)), based on the C&P examination, citing a flat spinal contour. The panel agreed that a 10% rating, but no higher, was justified for combined ROM (greater than 170 degrees but not greater than 335 degrees), as reported on the MEB PT and VA examinations proximate to separation. 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 neck condition.

Chronic LBP. According to the STR and MEB NARSUM, the CI’s LBP condition began after the same MVA in October 2005. Lumbar spine X-rays at the time were normal. There was no surgical indication. The CI was treated conservatively and given a profile. The 7 February 2007 MEB PT examination, 3 months prior to separation, noted complaints of LBP. Physical examination showed no abnormal gait due to muscle spasm or guarding. There was no abnormal spinal contour. Repetitive thoracolumbar spine flexion was 55 degrees (normal 90) and combined ROM was 190 degrees (normal 240) with painful motion elicited. The therapist indicated an inclinometer was used for ROM measurements, and a goniometer was used for rotation measurements. The 12 March 2007 MEB NARSUM examination, 2 months prior to separation, noted complaints of LBP. Physical examination showed the CI’s ability to toe-heel walk, and bilateral straight leg raise testing for radiculopathy was negative. Bilateral lower extremity motor strength was 5/5 and deep tendon reflexes were 2+ (normal). Low back ROM was performed during the aforementioned MEB PT examination.

At the VA C&P examination, the CI reported LBP without radiation. Physical examination showed a normal gait and posture, with lumbar spinal tenderness. Goniometric-repetitive thoracolumbar spine flexion was 75 degrees and combined ROM was 225 degrees with painful motion.

The panel directed attention to its rating recommendation based on the above evidence. The PEB and the VA rated the LBP condition 0% and 10%, respectively, both coded 5237 (lumbosacral strain). The PEB citied ROM limited by pain. The VA based the rating on the C&P examination, citing limitation of flexion. 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), as reported on the VA examination proximate to separation. Although the MEB PT examination supports a 20% rating based on limitation of flexion, the panel noted greater probative value from the VA examination because it was the most proximate to separation and most VASRD complaint. 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 with incapacitating episodes for a higher rating under that formula. After due deliberation,

consideri ng all the evidence and mindful of VASRD §4.3 (reasonable doubt ), the panel recommends a disabili ty rating of 10% for the LBP condition, coded 5237.

BOARD FINDINGS: In the matte r of t he cervical degenerativedisc disease and IAW VASRD §4.71a, the panel recommends no change in t he PEB adjudicat io n. In the matte r of the low back pain, the panel recommends a disability rati ng of 10%, coded 5237 IAW VASRD §4.71a. There are no ot her conditions wit hin the pane l' s scope of review for consideration.

The panel recommends the Cl' s prior det erminat ion be mo difie d as follows, effective the date of medica l separation:

CONDITION	VASRDCODE	PERMANENT RATING	
Cervica l Degenerative Disc Disease	5299-5242	10%	
Chronic Low Back Pain	5237	10%	
	COM BINED	20%	

The following documentary evidence was considered:

AR20200004032,

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

Dear	:

The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability. I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation. This will not result in any change to your separation document or the amount of severance pay. A copy of this decision will be filed with your Physical Evaluation Board records. I regret that the facts of the case did not provide you with the outcome you may have desired.

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.

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

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