RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:	CASE:  PD1200742
BRANCH OF SERVICE:  Army	BOARD DATE:  20130409
SEPARATION DATE:  20021017

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SGT/E-5(91W/PRACTICAL NURSE) medically separated for neck pain due to cervical degenerative disk disease (DDD).  The pain started while working in the emergency room in Korea in 1999.  The neck 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 U3 profile and referred for a Medical Evaluation Board (MEB).  The neck condition, characterized as cervical DDD, was forwarded to the Informal Physical Evaluation Board (IPEB) as medically unacceptable IAW AR 40-501.  No other conditions were submitted by the MEB.  The IPEB adjudicated chronic neck pain as unfitting rated 20% with application of the US Army Physical Disability Agency (USAPDA) pain policy and the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI appealed to the Formal PEB; however, he withdrew his appeal, and was medically separated with a 20% disability rating.

CI CONTENTION:  The CI writes: “The degree of pain and suffering related to disc conditions that have caused chronic pain condition.  Hypertension which started in the military and continues.  Hearing loss/tinnitus which has caused a depressive condition.  Tendonitis in ankles and knees all (can’t make out word) I sleep very little.  Pain and depression—inner ear nerve (can’t make out word) have periods of anxiety—depression.  Panic attacks that are related to ongoing conditions.  I have HTN had readings greater than 100 diastolic that were (can’t read word) and headaches now I’m on medication.”

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 rating for the unfitting neck pain is addressed below.  The contended conditions of hypertension, hearing loss/tinnitus, and depression are not within the DoDI 6040.44 defined purview of the Board.  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 respective Service Board for Correction of Military Records.  The Board acknowledges the CI’s information regarding the significant impairment with which his service-connected condition continues to burden him; but, must emphasize that the Disability Evaluation System (DES) has neither the role nor the authority to compensate members for anticipated future severity or potential complications of conditions resulting in medical separation.  That role and authority is granted by Congress to the Department of Veterans Affairs (DVA), operating under a different set of laws.

RATING COMPARISON:  

Service IPEB – Dated 20020703	VA - (7 Mos. Pre-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
CHRONIC NECK PAIN  DUE TO CERVICAL DDD	5099-5003	20%	DDD OF THE CERVICAL SPINE	5010-5293	10%	20020321	
No Additional MEB/PEB Entries	Other x 8	20020321	
Combined:  20%	Combined:  60%	
Derived from VA Rating Decision (VARD) dated 20021121 (most proximate to date of separation [DOS]).   

ANALYSIS SUMMARY:   

CHRONIC NECK PAIN.  The CI’s history of chronic neck pain in 2001 was preceded by a history of shoulder pain in 1999.  Since that time he reported pain in neck and thoracic spine, radiation to left arm and numbness/burning sensation with and without associated activity.  He was treated conservatively, and underwent manipulation therapy with unsustained improvement.  Magnetic resonance imaging (MRI) of the thoracic spine dated 17 December 2001, was normal; however, the cervical spine showed a C3-4 disk bulge/osteophyte complex which touches the thecal sac.  The neural foramen were narrowed bilaterally secondary to vertebral and facet joint hypertrophy; similar findings were noted at C5-6, and C6-7.  On 1 March 2002, approximately 7 months prior to separation, orthopedic examination revealed normal sensory, motor and reflex examinations, and a positive spurling test (suggests nerve root compression).  There was focal tenderness to palpation; however, no spasms or neurological deficits were noted.  At the MEB narrative summary (NARSUM) evaluation, 3 March 2002, approximately 7 months prior to separation, the CI reported neck, shoulder and back pain with spasms on a regular basis.  On physical examination, gait was not recorded; there was full cervical range-of-motion (ROM) with pain.  Sensation was intact in all extremities and motor strength was normal; reflexes were symmetrical.  The CI’s SF 2808 MEB 3 March 2003, on examination, noted there was cervical spine tenderness to palpation with pain.  Neurovascular exam was noted to be intact.  At the Compensation and Pension (C&P) examination, 21 March, 2002, 7 months prior to separation, the CI reported the pain was constant and radiated to his lower back and left arm.  The CI described numbness of left arm with lifting.  Physical examination revealed normal gait and posture, normal strength and reflexes, and full cervical ROM.  

The Board directs attention to its rating recommendation based on the above evidence.  The PEB rated the condition under the degenerative arthritis code of 5003 at 20%, the maximum rating allowed under this code, and applied the pain policy, citing marked and frequent pain.  The VA rated the condition using the 5293 code (intervertebral disc syndrome) and assigned a rating of 10% because there was full ROM of the cervical spine with pain.  The Board considered a rating under this code since the CI reported radicular symptoms; however, after discussion, the Board agreed there was no evidence of ratable peripheral nerve impairment in this case, since no motor weakness was present and sensory symptoms had no functional implication.  There was no evidence of incapacitating episodes for a higher rating under 5293.  Given the record of evidence the Board could find no other applicable VARSD codes for consideration.  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 adjudication for the chronic neck pain 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.  As discussed above, PEB reliance on the USAPDA pain policy DoDI 1332.39 for rating chronic neck pain was operant in this case and the condition was adjudicated independently of that policy by the Board.  In the matter of the chronic neck pain 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 recharacterization of the CI’s disability and separation determination, as follows:  

UNFITTING CONDITION	VASRD CODE	RATING	
Chronic Neck Pain	5003	20%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20120604, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

	Physical Disability Board of Review

SFMR-RB									

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(TAPD-ZB), 

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for AR20130009521 (PD201200742)

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						
						         (Army Review Boards)

CF: 
(  ) DoD PDBR
(  ) DVA