RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2013-02571
BRANCH OF SERVICE:  Army	BOARD DATE:  20150205
SEPARATION DATE:  20050725

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-6 (Radio Operator-Maintainer Supervisor) medically separated for chronic neck pain.  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 U3 profile and referred for a Medical Evaluation Board (MEB).  The neck condition, characterized as “neck pain with C7 radiculitis and cervical arthritis” was the only condition forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The Informal PEB adjudicated “chronic neck pain secondary to degenerative disk disease without neurologic abnormality” as unfitting and rated 10% with likely application of Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  “Diagnosed with PTSD with recent hospitalization.”

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:

Service IPEB – Dated 20050523 | VA - (1 month post separation)
Condition | Code | Rating | Condition | Code | Rating | Exam
Chronic Neck Pain Secondary To Degenerative Disk Disease | 5299-5242 | 10% | Residuals Of Cervical Spine Injury with Degenerative Disk Disease | 5242 | 10% | 20050831
Other x 0 (Not in Scope) | Other x 5 | STR
Rating:  10% | Combined:  50%
Derived from VA Rating Decision (VARD) dated 20051108 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Chronic neck Pain.  The narrative summary (NARSUM) notes the CI was injured during a bad parachute jump on 22 April 2004, with loss of consciousness.  Immediate head and neck computed tomography (CT) was normal.  The CI was released the next day and placed on temporary profiles for neck pain and headaches.  The CI had persistent neck pain and magnetic resonance imaging (MRI) on 12 November 2004 noted mild midline disc protrusions of the lower cervical spine, without nerve impingement or spinal stenosis.  Physical therapy (PT) did not resolve the neck pain and the CI was evaluated by orthopedics, neurosurgery, pain management, and physical medicine.  Ortho on 8 February 2005, noted full cervical range-of-motion (ROM) with painful motion, no tenderness to palpation (TTP) or muscle spasms, and normal reflexes.  At a pain management evaluation on 11 March 2005 the CI reported no upper extremity symptoms and there was reduced cervical ROM with normal strength and TTP of the cervical spine (facet pain), with positive evidence of bilateral cervical radiculitis. (C7).  At a neurosurgical evaluation on 25 March 2005 the CI reported neck pain that radiated to the shoulders and numbness and tingling (N/T) of the right upper extremity (RUE) with arms overhead.  Repeat cervical MRI on 20 April 2005 showed mild degenerative disc disease without evidence of spinal canal stenosis, nerve encroachment, or vertebral instability or compression.  Physical medicine evaluation on 20 April 2005 noted normal cervical ROM with no TTP and no evidence of nerve compression at the wrist.  Strength, sensation, and reflexes of the BUE were normal and electrodiagnostic studies (EMG) were normal, without evidence of cervical radiculopathy.  According to the NARSUM the CI was not considered a surgical candidate and was scheduled for an epidural steroid injection (ESI) of the cervical spine and an MEB was recommended by Orthopedics.

At the MEB examination on 22 April 2005, 3 months prior to separation, the CI reported constant neck pain increased by activity and relieved by rest and pain medications.  At the time the CI was pending a cervical ESI.  The MEB physical exam noted decreased cervical ROM, measured and reported by PT on 18 April 2005 reported as follows:

Cervical spine flexion 11° with 6/10 pain, extension 11° with 6/10 pain, right side bend 12° with 4/10 pain, left side bend 22° with 5/10 pain, right rotation 41° with 4-5/10 pain, left rotation 44° with 4-5/10 pain flexion 11°

In addition to the previously noted imaging studies, the MEB examination noted normal cervical X-rays 2 November 2004 and 25 March 2005.  At the VA Compensation and Pension (C&P) General examination on 31 August 2005, a month after separation, the CI reported chronic daily neck pain without radiculopathy.  The neck pain was reported to be increased by lifting and decreased by activity limitations and medication within 30 minutes.  There was TTP of the cervical spine without muscle spasm and normal strength, sensation, and reflexes of both upper extremities (UE).  ROM was full flexion (normal 45 degrees), with combined ROM of 295 degrees (normal 340 degrees), with painful motion, without additional functional impairment following repetitive use.  Cervical X-rays were reported as normal.  The VA C&P neurological examination on 9 September 2005 focused on the CI’s claimed headache condition, but the examination noted symmetrical UE reflexes, with normal strength and sensation.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the neck condition 10%, coded 5299-5242 (analogous to spinal arthritis) and the VA rated it 10%, coded 5242 (spinal arthritis).  The Board noted the marked discrepancy between the PT MEB ROM and the General C&P examination and deliberated how to reconcile them.  Descriptive ROM noted throughout treatment notes in the STR was indicated in alternating evaluations as “full,” “reduced,” then “normal,” with the normal ROM observation following the PT MEB ROM by 2 days.  The PT MEB ROM was reported with pain levels for each ROM notated.  Member consensus based on the totality of the evidence in record, was that this likely reflected the ROM at which pain began, rather than the point beyond which the CI could not move any further, as there was no support elsewhere in the record for severely limited cervical ROM.  The Board then agreed that the ROM evidence as analyzed supports a 10% rating IAW with the VASRD spine rating rules in effect at separation based upon combined ROM of “greater than 170 degrees and not greater than 335 degrees.”  The Board reviewed to see if a higher evaluation was supported, but there was no evidence of “muscle spasm or guarding severe enough to result in … an abnormal spinal contour,” ankylosis, or incapacitating episodes due to the neck condition.  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.

The Board also considered if additional disability rating was justified for peripheral nerve impairment related to the neck condition.  Board precedent is that a functional impairment tied to fitness is required to support a recommendation for addition of a peripheral nerve rating at separation.  At the pain management evaluation the CI reported symptoms of neck pain that at times radiated to the shoulders and N/T of the RUE, with the arm overhead.  All examinations in record documented normal bilateral UE strength, sensation, and reflexes and EMG showed no evidence of an UE radiculopathy.  Radiating pain from the neck condition is subsumed under the general spine rating criteria, which specifically states “with or without symptoms such as pain (whether or not it radiates)”and there is no evidence in this case that there was any UE motor or sensory deficit that could be described as functionally impairing.  Therefore, the Board concluded additional disability rating for peripheral nerve impairment could not be recommended.

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.

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 20131203, 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, AR20150010574 (PD201302571)

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

PD-2013-02571