RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2014-01301
BRANCH OF SERVICE:  Army	BOARD DATE:  20141218
SEPARATION DATE:  20020817

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5 (Heavy Equipment Mechanic) medically separated for chronic cervical pain with spondylosis at C5-6, C6-7.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS) or satisfy physical fitness standards.  He was issued a permanent U3 profile and was referred for a Medical Evaluation Board (MEB) by a MOS Medical Retention Board (MMRB).  The chronic cervical pain with spondylosis at C5-6, C6- condition, characterized as “mild cervical spondylosis” and “chronic neck pain,” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB also identified and forwarded two other conditions.  The Informal PEB adjudicated “chronic cervical pain with spondylosis at C5-6, C6-7” as unfitting, rated 10%, with likely application of the VA Schedule for Rating Disabilities (VASRD).  The remaining conditions were determined to be not unfitting.  The CI made no appeals and was medically separated.

CI CONTENTION:  “Please consider all conditions” 

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 20020501 | VA - (2 Mos. Pre-Separation)
Condition | Code | Rating | Condition | Code | Rating | Exam
Chronic Cervical Pain w/Spondylosis at C5-6, C6-7 | 5299-5295 | 10% | Degenerative Disc Disease Cervical Spine | 5293 | 20% | 20020627
Chronic Shoulder Pain | Not Unfitting | Right Shoulder Strain | 5203 | 10% | 20020627
| | Left Shoulder Strain | 5203 | 10% | 20020627
Bilateral Inguinal Hernias | Not Unfitting | Right & Left Inguinal Hernias | 7338 | 0% | 20020627
Other x 0 | Other x 3 | 20020627
Combined:  10% | Combined:  30%
Derived from VA Rating Decision (VARD) dated 20020725 (most proximate to date of separation [DOS])

ANALYSIS SUMMARY:  

Chronic Cervical Pain w/Spondylosis at C5-6, C6-7Condition.  The CI experienced the insidious onset of chronic neck pain without any identifiable trauma.  His duty as a heavy equipment mechanic required extensive heavy lifting.  He experienced neck pain and headaches with wearing his Kevlar helmet and there were no radicular symptoms noted.  Plain film X-rays and a magnetic resonance imaging (MRI) study performed mid-2001 demonstrated mild degenerative disc changes especially at C5-7.  The narrative summary prepared 4 months prior to separation noted that the CI was evaluated by an MMRB and determined that he could not be retained in the Army.  The CI continued to have significant neck pain that occasionally radiated to the para-cervical region, as well as into the right shoulder.  At the VA Compensation and Pension exam performed 2 months prior to separation, the CI reported that the CI continued to experience discomfort in the cervical spine region without radicular-type symptoms.  Physical therapy and facet blocks did not produce much improvement.  The pertinent physical exam findings are summarized in the chart below.

The goniometric range-of-motion (ROM) evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.

Cervical ROM (Degrees) | PT ~ 6 Mo. Pre-Sep | VA C&P ~ 1 Mo. Pre-Sep
Flex (45 Normal) | 30 | 45
Combined (340) | 200 | 340
Comment | Pos. painful motion; Normal strength & reflexes; Decreased light touch | Pos. painful motion; Normal strength, reflexes & sensation
§4.71a Rating: old spine rules | 10% or 20% (PEB 10%) | 10% (VA 20%)
§4.71a Rating: current spine rules | 10% | 10%

The Board directed attention to its rating recommendation based on the above evidence.  The PEB applied the analogous VASRD code 5299-5295 (lumbosacral strain) and rated it 10% consistent with “with characteristic pain on motion.”  The VA applied code 5293 (intervertebral disc syndrome) and rated it 20% citing “…recurring attacks of moderate degenerative disc disease.”  The Board noted that the evidence does not support application of code 5293 as the CI did not have MRI findings or manifest symptoms consistent with an intervertebral disc syndrome.  The 2002 VASRD coding and rating standards for the spine, which must be applied to the Board’s recommendation IAW DoDI 6040.44, differ significantly from the current §4.71a General Rating Formula for the Spine.  The earlier criteria were subject to the rater’s opinion regarding degree of severity, as opposed to the more objective current standards with quantifiable rating thresholds grounded in ROM measurements.  The PEB’s application of 5295 was consistent with the 10% rating under that code as the CI did not meet the requirements for to 20% rating.  
Additionally, if either code 5290 or the current rating formula for diseases of the spine were applied, the ROM measurements documented either both exam was consistent with the 10% rating under either criteria.  There was no appropriate coding/rating scheme that would result in 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 chronic cervical pain w/spondylosis at C5-6, C6-7 condition.

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that the chronic shoulder pain and bilateral inguinal hernias conditions were not unfitting.  The Board’s threshold for countering fitness determinations is higher than the VASRD §4.3 (reasonable doubt) standard used for its rating recommendations, but remains adherent to the DoDI 6040.44 “fair and equitable” standard and requires a preponderance of evidence.  The chronic shoulder pain and bilateral inguinal hernias conditions were not profiled or implicated in the commander’s statement and were not judged to fail retention standards.  All were reviewed by the action officer and considered by the Board.  There was no performance-based evidence from the record that any of these conditions significantly interfered with satisfactory duty performance.  After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the any of the chronic shoulder pain and bilateral inguinal hernias contended conditions and so no additional disability ratings are 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 chronic cervical pain w/spondylosis at C5-6, C6-7 condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended bilateral inguinal hernia and chronic shoulder pain conditions, the Board unanimously recommends no change from the PEB determinations as not unfitting.  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 20140418, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

	
XXXXXXXXXXXXXXX
President
DoD 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, AR20150009558 (PD201401301)

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-2014-01301