RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  	BRANCH OF SERVICE:  Army
CASE NUMBER:  PD1201486	SEPARATION DATE:  20070731
BOARD DATE:  20130417

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SGT/E-5 (19K20/M1 Armor Crewman), medically separated for chronic neck pain.  The CI injured his neck when his vehicle was struck by an improvised explosive device (IED) blast in June 2005.  He did not improve adequately with physical and chiropractic therapy, joint injections, and other non-operative pain management strategies to meet the physical requirements of his Military Occupational Specialty (MOS) or world-wide deployment.  He was issued a permanent U3 profile and referred for a Medical Evaluation Board (MEB).  Chronic non-radicular neck pain was forwarded to the Physical Evaluation Board (PEB) as medically unacceptable IAW AR 40-501.  No other conditions were listed on the DA Form 3947.  The PEB adjudicated the chronic neck pain as unfitting, rated 10%, with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  “TBI, neck and back injury and shoulder, and knee, PTSD symptoms are a lot worse than diagnosed.” 

SCOPE OF REVIEW:  The Board wishes to clarify that the scope of its review as defined in DoDI 6040.44, Enclosure 3, paragraph 5.e.(2) is limited to those conditions which were determined by the PEB to be specifically unfitting for continued military service; or, when requested by the CI, those condition(s) “identified but not determined to be unfitting by the PEB.”  The ratings for unfitting conditions will be reviewed in all cases.  The neck condition requested for consideration meets the criteria prescribed in DoDI 6040.44 for Board purview, and is accordingly addressed below.  The other requested conditions (traumatic brain injury [TBI], back, shoulder, knee, and posttraumatic stress disorder [PTSD]) are not within the Board’s purview.  Any condition 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.  

RATING COMPARISON:

Service IPEB – Dated 20070619 | VA (~1 Mos. Post-Separation) – All Effective Date 20070801
Condition | Code | Rating | Condition | Code | Rating | Exam
Chronic Neck Pain | 5237 | 10% | Cervical Strain | 5237 | 20% | 20070917
No Additional MEB/PEB Entries | Other x 7 | 20070917
Combined:  10% | Combined:  40%
Derived from VA Rating Decision, dated 20080206 (most proximate to the date of separation)

ANALYSIS SUMMARY:  The Board acknowledges the CI’s information regarding the significant impairment with which his service-connected conditions continue to burden him; but, must emphasize that the Disability Evaluation System 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 Veteran Affairs, operating under a different set of laws.

Chronic Neck Pain Condition.  There were two goniometric range-of-motion (ROM) evaluations in evidence, with documentation of additional ratable criteria, which the Board weighed in arriving at its rating recommendation; as summarized in the chart below.

Cervical ROM
(degrees)

MEB ~2 Mo. Pre-Sep
(20070530)

VA C&P ~2 Mo. Post-Sep
(20070917)

Flex (45 Normal) | 45 | 45
Ext (45) | 30 | 45
R Lat Flex (45) | 40 | 45
L Lat Flex (45) | 40 | 45
R Rotation (80) | 70 | 80
L Rotation (80) | 70 | 80
COMBINED (340) | 295 | 340
Comment | | Pain on motion with ROM tests except L & R rotation
§4.71a Rating | 10% | 0%

The CI sustained a compression injury to his neck when he hit his head on the canopy of his Bradley during the IED explosion in June 2005 in Iraq.  The CI complained of neck and shoulder pain following the accident.  The service treatment records indicate that the CI was evaluated by physical therapy (PT) on 16 March 2006.  The chief complaint was noted as “right rhomboid pain spasms;” the CI complained of right shoulder and neck pain which he rated 4/10.  An X-ray performed on 16 March 2006 revealed “slight scoliosis with straightening of the normal lordosis, suggesting muscular spasm” and what appeared to be posterior displacement of C4-5 vertebral body with respect to the adjacent vertebrae (retrolisthesis) and a possible narrowing at C5-6, C7-T1, and possibly C4-5.  There was no evidence of fracture or dislocation.  The PT treatment consisted of joint mobilization, heat hot packs, and cervical traction, but the CI reported no resolution of his symptoms.  The CI was evaluated and treated in the chiropractic clinic starting in July 2006.  The initial chiropractic note dated 11 July 2006 reported spasm of the sternocleidomastoid muscle on the right, spasm of the scalene muscle on the right, spasm of the paracervical muscle on the right, and decreased lordosis of the cervical spine.  The subsequent notes through 3 August 2006 have the same findings and appeared to be from the use of the “copy forward” function of the electronic medical record.  The CI was seen in the primary care clinic on 8 August 2006 and requested an orthopedic referral due to continued pain.  It appears that the CI was treated in the family medicine with non-steroidal anti-inflammatory drugs, with a plan to order a magnetic resonance imaging (MRI) and then refer to the pain and orthopedic clinics.  An MRI of the C-spine performed on 27 October 2006 revealed no obstructive lesions, disk herniation, and foraminal and/or canal compromise.  The signal from the cord was reported as normal and the final impression was a “normal MRI of the cervical spine.”  The CI was evaluated by a private practice pain specialist on 19 January 2007.  The examiner noted some mild tenderness in the paravertebral areas on the left side of the neck at C2, C4-5, and C5-6.  There was also some mild tenderness on the right at C3-4.  There was no palpable spasm in the trapezius, but there was definite trigger point/nodule just proximal to the tip of the scapula on the right.  ROM testing was not reported.  The CI was prescribed an analgesic patch and a muscle relaxant and later received trigger point injections.  The CI reported no response to these treatments and requested that his care be transferred to the Army pain clinic.  The CI was seen for an initial orthopedic evaluation on 19 March 2007.  The examiner noted that the CI would be starting treatments in the pain clinic and should return once those treatments were completed.  The CI eventually received facet injections in the army pain clinic with no benefit.  The MEB narrative summary (NARSUM), dated 30 May 2007, 2 months prior to separation, reported pain 7-8/10 with 6/10 on his best days and 9/10 on his worst days.  He reported having pain while exercising, running, and even while driving.  He also reported having difficulty sleeping at night.  The MEB physical examination performed on 17 April 2007 recorded ROM as displayed in the above chart.  The NARSUM reported that the CI had some mild midline tenderness at C3- C5 on examination.  There were no paraspinal muscle spasms and the neurological examination was reported as normal.  At the time of the NARSUM, the CI was working in his primary MOS, but complained that he experienced neck pain with all of his tasks.  The CI was unable participate in other military functions.

The VA Compensation and Pension (C&P) examination performed on 17 September 2007, 6 weeks after separation, reported that the CI continued to experience neck and shoulder pain 8/10.  The CI reported “chronic neck stiffness but there is no radiation into the upper extremities.”  The examiner reported that the CI did not use a brace or assistive device for ambulation.  The CI’s weight was reported as 235 pounds.  He had normal posture and gait.  There were no gross signs of abnormal contour of the cervical spine and the examiner specifically noted that there was no torticollis, scoliosis or kyphosis; however, there was palpable knotting consistent with spasm in the mid-portion of the right trapezius muscle.  The ROM examination of the cervical spine is shown in the chart above.  The shoulder examination was within normal limits with the exception of painful motion with “extension” at 30 degrees.  The examiner noted that the pain with extension was felt in the right trapezius muscle.  X-ray examination performed on 17 September 2007 reported “loss of normal cervical lordosis most likely positional, given that the chin appears to be tucked.  Spasm could also account for the appearance.”  The radiologist’s impression was: “No cause for pain identified.”

The Board directs attention to the rating recommendation based on the above evidence.  The PEB and the VA coded the chronic neck pain condition using VASRD code 5237.  The PEB assigned a 10% disability rating and the VA assigned a 20% rating, due to the muscle spasms.  The Board agreed that the evidence did not support a rating of 30% or higher under the code 5237.  The Board focused on the 10% and 20% rating criteria for code 5237.  The criteria for a 20% rating requires that forward flexion of the cervical spine  be greater than 15 degrees but no higher than 30 degrees; a combined ROM no higher than 170 degrees; or the presence of muscle spasms or guarding severe enough to result in an abnormal gait, abnormal spine contour, scoliosis, reversed lordosis, or  abnormal kyphosis.  Although the initial X-ray examination, 16 months prior to separation, reported findings of “probable” muscle spasms, the X-ray performed 2 months following separation reported that the loss of the normal lordosis was most likely positional.  No spasm of the paracervical muscles was documented other than the mid right trapezius.  The examiner did not observe an abnormal contour of the neck or an abnormal gait.  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.  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 pain condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.

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 | 5237 | 10%
COMBINED | 10%

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20120620, 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 AR20130010228 (PD201201486)

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