RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2013-02488
BRANCH OF SERVICE:  Army	BOARD DATE:  20150402
SEPARATION DATE:  20050518

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5 (Food Service Specialist) medically separated for a spinal cord syrinx condition.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards.  He was issued a permanent P3 profile and referred for a Medical Evaluation Board (MEB).  The “thoracic spinal cord syrinx” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB also identified and forwarded, as meeting retention standards, two other conditions (recurrent knee pain and pes planus) for PEB adjudication.  The Informal PEB adjudicated “spinal cord syrinx” as unfitting, rated 10%, stating “this is likely a condition that existed prior to service and was not permanently service aggravated but is compensable in accordance with 10 USC 1207a (eight year rule).”  The remaining conditions were considered by the PEB and found to be not unfitting and therefore not ratable.  The CI made no appeals and was medically separated.  

CI CONTENTION:  The CI elaborated no specific contention in his application.  

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e. (2).  It is limited 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 PEB, but determined to be not unfitting.  Any conditions outside the Board’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/Naval Records.  Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation.  The Board 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, operating under a different set of laws.  The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation. 

RATING COMPARISON:  

IPEB – Dated 20050408 | VA* - (~11 Mos. Post-Separation)
Condition | Code | Rating | Condition | Code | Rating | Exam
Spinal Cord Syrinx | 5299-5238 | 10% | Lumbar and Thoracic Pain, with Evidence of T8-T9 Syrinx and Degenerative Disc Disease, L5-S1 | 5242 | 20% | 20060427
Other MEB/PEB Conditions x 2 (Not In Scope) | Other x 8
RATING:  10% | RATING:  60%
*Derived from VA Rating Decision (VARD) dated 20060717 (most proximate to date of separation (DOS)).  

ANALYSIS SUMMARY:  

Spinal Cord Syrin.  The CI had a long history of mid-back and low back pain dating back to the mid-nineties which were thought to be musculoskeletal in nature.  In early 2003, he began to have pain in the lower chest area and began an extensive evaluation over the next year and a half.  This led to an imaging of the thoracic spine, on 9 November 2004, which showed a syrinx (a fluid filled cavity) of the spinal cord at T8-9.  He was then referred to a spine surgeon.  The evaluation on 15 December 2004 showed a normal neurological examination and normal range-of-motion (ROM) of the thoracic spine and essentially normal ROM of the lumbar spine in flexion and extension.  He was referred to neurosurgery and seen on 26 January 2005.  The gait and neurological examination were normal.  The sensory distribution of the pain was compatible with the location of the syrinx; however, the neurosurgeon wrote that he was not “absolutely sure that the syrinx is the cause of his pain.”  Surgery was not recommended at that time.  The CI was not thought to be able to “function effectively as a soldier.”  At the MEB examination on 2 March 2005, 2 months prior to separation, the examiner noted increased sensation at the T8-12 levels.  The narrative summary (NARSUM) was dated 30 March 2005.  The CI reported constant pain about the lower chest, right upper abdomen, and right flank which was aggravated by heavy lifting and certain movements.  The examiner referred to the MEB examination on 2 March 2005 (same examiner), but also noted that the neurological examination was normal.  There was no spasm and the lumbar examination was normal.  

At the VA Compensation and Pension (C&P) examinations performed on 27 April 2006, over 11 months after separation, the CI reported pain in both feet and knees.  He also reported pain from the back condition with progressive weakness; however, he had lost no work secondary to the back and was an officer in the federal prison.  This is described as an occupation which requires physical fitness and sound health.  On examination, he had an antalgic (painful) gait with spasm of the para-thoracic muscles.  There was moderate guarding and tenderness and mild atrophy.  His posture was normal.  The abnormal gait was not thought to be secondary to these.  The ROM was reduced as charted below.  The pain increased with repetition with further limitation in motion.  There was symmetric diminishment in sensation in both lower extremities, but not in the distribution expected from the syrinx.  The neurological examination was otherwise normal.  

The goniometric ROM evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.

Thoracolumbar ROM
(Degrees)

Spine Center ~5 Mos. Pre-Sep

MEB ~3 Mos. Pre-Sep

VA C&P ~11 Mos. Post-Sep

Flexion (90 Normal) | Fingertips to the floor | 70 | 50 (40 with repetition)
Comment | Above for lumbar spine.  Thoracic spine normal. | Lumbar ROM | Decreased with repetition Working as a prison guard
§4.71a Rating | 0% | 10% | 20%

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB rated the thoracic back condition at 10% using the analogous code 5299-5238 (spinal stenosis).  The VA rated the back at 20%, citing the C&P ROM values, using the code 5242 (degenerative arthritis of the spine).  The Board first considered if an unfitting radiculopathy was present at separation.  The sensory loss was not in the distribution from the syrinx.  The motor and reflex examinations were normal.  The evidence did not support the presence of a separately unfitting radiculopathy at separation.  The Board then considered the rating.  The MEB examination supported a 10% rating for reduced flexion.  The evaluation by the neurosurgeon supports a 0% rating.  The VA C&P, almost a year after separation, supported a 20% rating.  However, the CI was working as a corrections officer in the prison system and reported no loss of work time from the back.  This is not consistent with the limitation in flexion recorded on the VA C&P examination, reducing the probative value of this examination.  After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the spinal cord syrinx condition.  

BOARD FINDINGS:  IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB will not be considered by the Board to the extent they were inconsistent with the VASRD in effect at the time of the adjudication.  The Board did not surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD were exercised.  In the matter of the spinal cord syrinx condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration.  

RECOMMENDATION:  The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination. 

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20131119, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

XXXXXXXXXXXXXXX 
President 
DoD Physical Disability Board of Review

SAMR-RB									

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXXXXXXX, AR20150015858 (PD201302488)

I have reviewed the enclosed Department of Defense Physical Disability Board of Review (DoD PDBR) recommendation and record of proceedings pertaining to the subject individual.  Under the authority of Title 10, United States Code, section 1554a,   I accept the Board’s recommendation and hereby deny the individual’s application.  
This decision is final.  The individual concerned, counsel (if any), and any Members of Congress who have shown interest in this application have been notified of this decision by mail.

 BY ORDER OF THE SECRETARY OF THE ARMY:

Encl						     XXXXXXXXXXXXXXXXXXXX
						     Deputy Assistant Secretary of the Army
						          (Review Boards)
						         
CF: 
(  ) DoD PDBR
(  ) DVA

PD-2013-02488