RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXX	CASE:  PD-2014-00972
BRANCH OF SERVICE:  AIR FORCE	BOARD DATE:  20140715
SEPARATION DATE:  20081124

 SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SSGT/E-6 (2A6X5/Hydraulic Mechanic) medically separated for chronic neck pain and right foot pain.  The conditions could not be adequately rehabilitated to meet the physical requirements of his Air Force Specialty or satisfy physical fitness standards.  He was placed on limited duty and referred for a Medical Evaluation Board (MEB).  The cervical spine condition, characterized as “facet syndrome cervical,” was forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123.  No other conditions were submitted by the MEB, but the applicant submitted an e-mail to the MEB Liaison referencing other medical conditions.  The Informal PEB adjudicated “chronic neck pain, cervical facet arthropathy” and “right foot pain, status-post sesamoid fracture” as unfitting, rated 10% and 10% respectively, citing criteria of the VA Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  “Discharged medically at 20% then rate at 80% by VA that same month.”

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 cervical spine and right foot condition is addressed below and, no additional conditions are within the DoDI 6040.44 defined purview of the Board.  The Board acknowledges the CI’s contention for ratings of his VA-rated conditions (hearing loss, wrist and bilateral shoulders and knees) which were not addressed within the disability evaluation system; however, they are not within the scope of the Board.  Disability compensation may only be offered for those conditions that cut short the member’s career, while the VA operating under a different set of laws may compensate for all service-connected conditions.  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.

RATING COMPARISON:

Service IPEB – Dated 20081001	VA - (6 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Neck pain, Cervical	5299-5237	10%	DDD of Cervical Pain w/ HA and Sleep Disturbances	5010-5242	10%	20090514	
Right Foot Pain	5299-5284	10%	Residuals of Sesamoid Fracture of the Right Foot	5299-5284	0%	20090514	
MEB/PEB entries not in scope x 0	Other x 11	20090514	
Combined:  20%	Combined:  70%*	
Derived from VA Rating Decision (VARD) dated 20090528 (most proximate to date of separation [DOS]).  *Increased to combined VA 80% by VASRD dated 20110928.

ANALYSIS SUMMARY:

Cervical Neck Pain Condition.  The narrative summary (NARSUM) noted neck pain with headaches following a motor vehicle accident (MVA) in January 2007.  Neck pain of a year in duration was noted as pain in the back of the neck radiating to the head and down to the shoulders.  Initial headaches following the MVA significantly improved after 6 months of therapy.  Pain was described as increased with sitting/standing and decreased with stretching.  Treatments with medications included narcotic pain medication, nerve blocks, epidural steroid injections and radio frequency nerve ablation.  A neurology consultation documented cervical spine range-of-motion (ROM) as “normal with flexion and extension.”  There was “very mild tenderness” and normal sensorimotor exams.  Assessment was “Cervical facet arthropathy with almost complete resolution of his symptoms after radiofrequency ablation of cervical medial branch nerves.”  The consultation noted the [CI] “…can return back to work without any restrictions.”  At the time of the NARSUM, the CI was on no medications.  The MEB physical exam noted neck pain on palpation with “limited range of motion (ROM) due to pain.”  There were no deficits noted on motor, sensory, or reflex exams and gait was normal.  Magnetic resonance imaging and C-spine X-rays were reported as normal.  Surgery was not recommended.

At the VA Compensation and Pension (C&P) exam performed 6 months after separation, the CI reported continued neck pain and associated daily headaches (all day) which caused difficulty falling asleep.  No medicine or treatment was being used.  Exam documented a normal gait with tenderness in the cervical spine area.  Cervical motion was forward flexion to 35 degrees (normal 45 degrees) and combined ROM to 285 degrees (normal 340 degrees) with pain on motion.  There was no additional loss of ROM on repetitive use.  Sensory, motor and reflex exams were normal.

The Board directs attention to its rating recommendation based on the above evidence.  The PEB’s 10% rating (5299-5237; cervical strain) and the VA’s 10% rating (5010-5242 traumatic degenerative arthritis of the spine) were both under the general rating formula for the spine.  That rating formula is with or without symptoms such as pain (whether or not it radiates), stiffness or aching in the area of the spine affected.  There was no indication of abnormal spinal contour due to muscle spasm or guarding, or forward flexion limited to 30 degrees or less to support any higher rating.  There was no benefit to either disability code and both were IAW VASRD 4.71a.

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, cervical facet arthropathy condition.

Right Foot Pain Condition.  The NARSUM noted difficulty running primarily attributed to foot pain.  The record noted bilateral foot fractures of the sesimoid bones from 2005, with resolution of the left foot, but prolonged profile restrictions due to the right foot condition.  He was referred to a civilian specialist in January 2007 for delayed fracture of the sesimoid bone.  Treatment notes from August 2008 indicate he had surgery on the right foot from a civilian provider, but no operative report was located.  The MEB physical exam noted normal toe, heel, and tandem gait and normal strength and sensation.  At the VA C&P exam performed 6 months after separation, the CI reported no foot symptoms and the examiner noted no abnormal finding, no flatfoot, and no deformities.  Sensory and motor exams were normal.

The Board directs attention to its rating recommendation based on the above evidence.  Both the PEB and VA rated the condition under code 5299-5284 (foot injuries, other) with the PEB’s 10% rating indicating “moderate” severity, and the VA’s 0% rating indicating less disability.  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 right foot 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, cervical facet arthropathy (with headache) condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the right foot 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.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140224, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

				
XXXXXXXXXXXXXX
President
Physical Disability Board of Review

SAF/MRB

Dear XXXXXXXXXXXXXX:

	Reference your application submitted under the provisions of DoDI 6040.44 (Title 10 U.S.C. §  1554a), PDBR Case Number PD-2014-00972.

	After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate.  Accordingly, the Board recommended no re-characterization or modification of your separation.

	I have carefully reviewed the evidence of record and the recommendation of the Board.    I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  Accordingly, I accept their recommendation that your application be denied.

							Sincerely,

							
XXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings