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AF | PDBR | CY2013 | PD-2013-02146
Original file (PD-2013-02146.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXX  CASE: PD-2013-02146
BRANCH OF SERVICE: Army  BOARD DATE: 20140812
SEPARATION DATE: 20050720


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SFC/E-7 (79R/Recruiter) medically separated for chronic neck and back conditions. The conditions 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 U3/L3 profile and referred for a Medical Evaluation Board (MEB). The neck and back conditions, characterized as “degenerative disk disease DDD, chronic neck pain and chronic back pain” were forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. The PEB adjudicated “chronic neck pain” and “chronic back pain” as unfitting, rated 10% and 10% respectively, citing c riteria of the VA Schedule for Rating Disabilities (VASRD). The CI made no appeals and was medically separated.


CI CONTENTION: The CI submitted a statement requesting the Board review his disability separation, taking into account his service career of 14 years. Specifically, he requested that his “military record and medical evaluations be reviewed and weighed together.” His complete submission is at Exhibit A.


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 those conditions identified but not determined to be unfitting by the PEB when specifically requested by the CI. The ratings for the unfitting neck and back conditions are addressed below; and, no additional conditions are within the DoDI 6040.44 defined purview of the Board. The Board noted the MEB forwarded “degenerative disk disease” is encompassed by the Board’s addressing the chronic back condition. Any conditions or contention not requested in this application, or otherwise outside the Board’s defined scope of review, remain eligible for future consideration by the Board for Correction of Military Records. The Board acknowledges the CI’s contention that his career be weighed and included with his medical evaluations in assessing his final disability rating at the time of his separation. The Board is required by law to assess the accuracy and fairness of the department disability determination in this case, and will utilize all available evidence to make a fair and equitable recommendation to the Secretary, based upon the facts of the case.


 RATING COMPARISON :

Service IPEB – Dated 20050517
 VA - (pre discharge exam*)
Condition
 Code Rating Condition Code Rating Exam
Chronic Neck Pain without Neurologic Abnormality 5299-5242 10% Disc Protrusion, Cervical Spine 5239 10% Pre-Sep exam*
Chronic Back Pain without Neurologic Abnormality 5299-5242 10% Degenerative Joint Disease, Thoracolumbar Spine 5242 10% Pre-Sep exam*
Other x 0 (Not in Scope)
 Other x 6 Pre-Sep exam*
Combined: 20%
 Combined: 50%
Derived from VA Rating Decision (VA RD ) dated 20 140311 ( most proximate VARD in evidence to date of separation [ DOS ] ).
ANALYSIS SUMMARY:

Chronic Neck Condition. The service treatment record (STR) had very few source documents in reference to the CI’s neck condition and most historical evidence was obtained from summary documents. Additionally, the record was inconsistent on the etiology of the CI’s neck pain condition citing both as a result of a motor vehicle accident and a non-traumatic insidious onset over time. Radiology work-up revealed a moderately sized C6-C7 disc protrusion on the left. Surgery was not recommended and he underwent two separate epidural steroid injections in July and August 2004. The injections provided temporary pain relief. There were no apparent periods of incapacitation or hospitalizations regarding his neck pain. At the MEB narrative summary (NARSUM) examination performed on 27 April 2005 (3 months prior to separation), the CI reported the inability to sit or stand for a prolonged period of time due to pain. The physical exam (PE) revealed limited motion without spasm. There was no comment in regards to painful motion. His diagnosis was chronic neck pain secondary to degenerative arthritis in the cervical spine. There was no original VA Compensation and Pension examination or VARD contained in the case file and a VARD 7 years remote from separation indicated a compensable cervical disc protrusion condition on a pre-discharge examination. The permanent profile listed neck pain as well as back pain whereas the commander’s statement was absent any comment in regards to a neck condition. The goniometric range-of-motion (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.

DOS 20050720
Cervical ROM
(Degrees) 		Neurosurgery
~11 Mo. Pre-Sep
(20040812)
MEB ~3 Mo. Pre-Sep
(20050427)
Flex (45 Normal) Normal 45
Extension (45) Normal 45
R Lat Flexion (45) Normal 30
L Lat Flexion (45) Normal 30
R Rotation (80) Normal 70
L Rotation (80) Normal 75
Combined (340) 340 295
Comment painful motion -
§4.71a Rating 10% 10%
invalid font number 31502
The Board directs attention to its rating recommendation based on the above evidence. Although the PEB and VA titled the unfitting cervical spine condition differently, they both rated 10% using similar spinal codes of 5242 (degenerative arthritis) and 5239 (segmental instability), respectively. Board members agreed that the MEB NARSUM provided the best probative value as to the CI’s neck condition near the time of separation and that the minimal limited ROM is compensable at the 10% level for the combined measured parameters. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB’s adjudication for the chronic neck pain condition.

Chronic Back Condition. Liken to the CI’s neck condition, there was minimal source documents specifying the chronic back condition. Originally diagnosed with back pain in September 2003, radiology examination revealed severe degenerative arthritis with multi-level disc protrusion involving the lumbosacral spine. The CI endorsed, “having some referred pain into his right leg.” A single STR entry dated 2 June 2004, listed low back pain (LBP) with right sciatica as the diagnosis. A neurosurgical evaluation performed on 12 August 2004 noted a normal gait, without radicular pain and or tenderness with nerve-stretching maneuvers. Thoracolumbar flexion was “mildly limited.” The neurosurgeon’s diagnosis was lumbar DDD without evidence of neurologic impairment. At the NARSUM the CI reported persistent and worsening LBP. The PE revealed a normal gait with limited motion without spasm. There was no comment in regard to painful motion. His diagnosis remained LBP secondary to DDD. The VARD indicated a compensable low back condition coded 5242 (degenerative arthritis) and rated at 10%. The commander’s statement implicated the back condition and its associated treatment as negatively affecting the CIs abilities and job performance. 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.

DOS 20050720
Thoracolumbar ROM
(Degrees)		 Neurosurgery
~11 Mo. Pre-Sep
(20040812)
MEB ~3 Mo. Pre-Sep
(20050427)
Flexion (90 Normal) ‘mildly limited’ 65
Extension (30) normal 15
R Lat Flexion (30) normal 3 0
L Lat Flexion (30) normal 3 0
R Rotation (30) normal 3 0
L Rotation (30) normal 30
Combined (240) - 2 00
Comment painful motion -
§4.71a Rating 10% 10%

The Board directs attention to its rating recommendation based on the above evidence. Likened to the previously described neck condition, both the PEB and VA similarly coded and rated the back condition at 10%. Board members agreed that the NARSUM provided the best probative value as to the CI’s back condition near the time of separation and that the 10% rating level was easily supported both by limited individual ROM as well as combined measurements. Board members also considered if the symptomatic right lower extremity radiculopathy type symptoms warranted additional disability rating; but, members agreed that the requisite link of neuropathy symptoms with functional impairment was not in evidence in this case. The pain component of a radiculopathy is subsumed under the general spine rating as specified in §4.71a. There are no alternative or analogous coding options which are applicable and or advantageous to the CI’s current 10% rating. Considering the totality of the evidence and mindful of VASRD §4.3 (reasonable doubt), members agreed that a disability rating of 10% for the LBP condition was appropriately recommended in this case.


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 chronic neck and back conditions and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB’s 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 20131029, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record






                          
XXXXXXXXXXXXXXXXX
President
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 XXXXXXXXXXXXXXXXX, AR20150002614 (PD201302146)

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

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