RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2013-01484
BRANCH OF SERVICE:  Army	BOARD DATE:  20141024
DATE OF PLACEMENT ON TDRL:  20041026
Date of Permanent SEPARATION:  20050426

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (13M/MRLS Rocket Crewman) medically separated for Intervertebral (cervical) disc syndrome and posttraumatic stress disorder (PTSD).  The conditions could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS) but he could perform and alternate physical fitness exam.  He was issued a permanent U3S3 profile and referred for a Medical Evaluation Board (MEB).  The cervical disk and PTSD conditions characterized as “cervicalgia degenerative disk disease (DDD) and posttraumatic stress disorder (PTSD),” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated “cervicalgia with DDD and PTSD” as unfitting, rated 10% and 10% respectively with likely application of VA Schedule for Rating Disabilities (VASRD) and IAW AR 635-40.  The applicant did not appeal and was medically separated.  

The CI later appealed to the Board for Correction of Military records (BCMR) for his PTSD condition only and was retroactively placed on the Temporary Disability Retired List (TDRL) with application of VASRD §4.129 for a temporary 50% rating.  The CI entered TDRL with a combined 60% rating.  The PEB adjudicated intervertebral (cervical) disc syndrome and PTSD as unfitting rated 10% and 10% respectively and removal from the TDRL.  The CI was retroactively removed from TDRL on 26 April 2005 and permanently separated.

CI CONTENTION:  “Please obtain VA Records indicating the extent of my disabilities.” 

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 cervicalgia condition is addressed below; the PTSD condition as already been re-adjudicated by the BCMR and is, therefore, outside the scope of the Board.  No additional conditions are 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 BCMR.

RATING COMPARISON:

Final Service PEB - 20110207	VA (3 Mo. Prior to Adjudication Date*) - Effective 20041027	
Condition	Code	Rating	Condition	Code	Rating	Exam	
		TDRL	Sep.					
*Intervertebral (cervical) disc syndrome	*5243	10%	10%	DJD, Cervical Spine	5242	20%	20040728	
Other x 1  (Not in Scope)	Other x 1	20040728	
Combined:  10% → 10%	Combined: 40%	
*Reflects VA rating exam proximate to TDRL placement; no VA rating evidence proximate to permanent separation. *Final PEB corrected condition name and rating.

ANALYSIS SUMMARY:

Intervertebral (Cervical) Disc Syndrome.  The CI hit his head against the roof of a military vehicle when it hit a bump in early July 2002.  X-rays of the cervical spine were normal.  He was managed conservatively and able to return to limited duty.  He then had recurrent neck pain with tingling of the fingers on right hand and back pain.  Conservative management, including medications, physical and chiropractic therapy and duty limitations did not resolve his symptoms.  The range-of-motion (ROM) was noted to be good at chiropractic visits on 20 January 2004 and 20 February 2004 as well as in a physical therapy note dated 23 February 2004.  At a neurology evaluation on 26 March 2004, the CI reported that the hand and finger numbness had resolved over a year earlier, but did endorse neck pain and muscle spasm.  His neck was noted to be supple with full ROM.  Extension of his neck was painful with resistance.  Axial compression of the neck was pain free (indicative of minimal pathology of the cervical spine and/or discs).  Sensory, motor and reflex examinations were normal; atrophy and spasm were absent.  Muscle tone and gait were normal.  X-rays of the cervical spine were normal.  A magnetic resonance imaging (MRI) on 19 May 2004 revealed minimal, multi-level DDD.  The narrative summary (NARSUM) was dated 16 June 2004.  The CI reported that he had been on light duty for the past 7 months and occasionally had radicular symptoms with running or quick movements.  He denied new trauma.  He was unable to wear body armor over 30 minutes without significant neck pain.  The ROM exceeded VA normal values for flexion at 60 degrees (VA normal is 45 degrees).  Extension and rotation were both reduced (10 degrees each from the VA normal values), but side bending was not recorded.  The Board noted that even if the side bending was recorded as 0 degrees each, the combined ROM would still be 230 degrees (VA normal is 340 degrees) which warrants a 10% rating IAW the VASRD.  The sensory, motor, and reflex examinations were normal.  No spasm was present.  There was midline tenderness over C6-T1.  Painful motion was not recorded.  At the MEB examination done the same day, the examiner documented “neck FROM” (free/full ROM).  The CI reported two cracked vertebrae and “bulged” discs in the neck.  The Board found no evidence for “cracked vertebrae” in the records.  At the VA Compensation and Pension (C&P) exam performed on 30 July 2004, 3 months prior to TDRL placement and 9 months prior to TDRL removal, the CI reported pain aggravated by activity and relieved with rest and medications.  He denied incapacitation and had lost no time from work.  It hurt to turn his head, but he was able to drive a car.  No history of intervening trauma from the original accident in 2002 was recorded.  On examination, the posture, gait and neurological examination were normal.  There was no radiation of pain with movement; spasm and tenderness were absent.  The flexion rounded to 20 degrees and the combined ROM rounded to 255.  For each value, the measured ROM values coincided precisely with the onset of pain.  X-rays were again normal.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the neck condition at 10% for both TDRL placement and removal, changing the code from 5242 (degenerative arthritis) to 5243 (intervertebral disc syndrome) as more reflective of the pathology.  The VA also used the 5242 code, but rated the neck at 20% using the VA C&P ROM values.  Both the PEB and VA examinations were proximate to TDRL placement although the VA examination was 6 weeks closer.  There were no examinations after these two and more proximate to TDRL removal.  Accordingly, the Board used the same information for TDRL placement and removal.  The VA examination showed flexion limited to 22 degrees (20 when rounded) which supports a 20% rating.  The PEB examination showed flexion in excess of the VA normal value, but did show reductions in extension and rotation.  It did not include side bending and was therefore incomplete.  The VA examination ROM values exactly coincided with the onset of pain for all six measurements.  It is most likely that the ROM measurements stopped at pain onset rather than at the actual limit, which typically is past the onset of pain.  Accordingly, the probative value of both examinations is compromised.  The Board reviewed the record.  The ROM of the neck was recorded as either normal or full on multiple examinations in the months leading up to the PEB by a physical therapist, chiropractor, neurologist and the MEB physical examiner.  No trauma was recorded to account for the marked decrease in ROM in the 6 weeks between the NARSUM and VA measurements.  In fact, on the VA examination, there was neither tenderness nor spasm to account for the limited motion.  The MRI showed minimal disc disease which would not be expected to result in this level of limitation.  Multiple X-rays of the cervical spine were normal.  The limitation recorded by the VA examiner is not explained by the remainder of the VA examination or the pathology in evidence in the records.  Accordingly, the Board assigned a higher value to the NARSUM ROM values.  The limitation in ROM supports a 10% rating.  Absent spasm, ankylosis, or incapacitation, the Board found no route to a higher rating.  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 neck 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 neck 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 20130923, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

				
XXXXXXXXXXXXXXX
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 XXXXXXXXXXXXXXX, AR20150004323 (PD201301484)

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