RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02147
BRANCH OF SERVICE:  Army	BOARD DATE:  20150313
SEPARATION DATE:  20040331

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5 (Blackhawk Helicopter Mechanic) medically separated for neck and back conditions.  The neck and back conditions 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 U3L3 profile and referred for a Medical Evaluation Board (MEB).  Chronic low back pain (LBP); degenerative disk disease (DDD), lumbar spine; chronic neck pain; and, chronic right C6 radiculopathy were forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The Informal PEB adjudicated “chronic neck pain…with intermittent right arm pain” and “chronic low back pain…MRI denotes degenerative disc disease” as unfitting, rated 10% and 10%, with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The chronic right C6 radiculopathy was determined to be not unfitting and therefore not rated.  The CI appealed to the Formal PEB which affirmed the PEB findings and ratings.  The CI was then 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 FPEB – Dated 20040109 | VA - (~3 Mos. Post-Separation)
Condition | Code | Rating | Condition | Code | Rating | Exam
Chronic Neck Pain… | 5299-5237 | 10% | Cervical Strain w/C6-7 Disc Bulge…C6 Radiculopathy | 5299-5237 | 10% | 20040709
Chronic C6 Radiculopathy | Not Unfitting | | | |
Chronic LBP…MRI denotes DDD | 5299-5237 | 10% | HNP, Lumbar Spine w/Radiculopathy | 5299-5243 | 20% | 20040709
Other x 0 (Not in Scope) | Other x 5
Combined Rating:  20% | Combined Rating:  40%
Derived from VA Rating Decision (VARD) dated 20041207 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:  IAW DoDI 6040.44, the Board’s authority is limited to making recommendations on correcting disability determinations.  The Board’s role is thus confined to the review of medical records and all evidence at hand to assess the fairness of PEB rating determinations, compared to VASRD standards, based on ratable severity at the time of separation; and, to review those fitness determinations within its scope (as elaborated above) consistent with performance-based criteria in evidence at separation.

Chronic Neck Pain with Intermittent Right Arm Pain.  The CI was seen in flight medicine on 6 February 2002 for a history of neck pain since a hard helicopter landing the previous November.  X-rays of the cervical spine were normal.  The range-of-motion (ROM) and neurological examination were normal.  He was referred to physical medicine and again had a normal examination including ROM as he did in a follow-up appointment in flight medicine on 22 February 2002.  An MRI on 27 February 2002 showed mild degenerative disc disease (DDD) at C6-7 with multi-level degenerative joint disease (DJD).  He was seen that day in physical medicine and thought to either have a C5 or C6 radiculopathy or a rotator cuff injury on the right.  Electrodiagnostic (EDX) testing on 29 May 2002 was normal.  A repeat MRI that day again showed DDD and DJD without definite nerve root compression.  His symptoms persisted and he was evaluated in neurosurgery on 10 January 2003 and thought to have a C6-7 disk herniation.  The neurological examination was normal.  On 18 February 2003, the CI underwent surgical repair of a torn cartilage in the right shoulder.  A pain clinic evaluation on 28 February 2003 again noted a normal neurological examination; a steroid injection was performed at that appointment.  Repeat EDX on 11 June 2003 revealed a chronic right C6 radiculopathy.  A repeat MRI on 16 June 2003 again showed DDD and DJD with a C6-7 disk bulge (herniated disk).  X-rays on 3 September 2003 showed a loss of cervical lordosis (curvature); this can be secondary to spasm.  It was otherwise normal.  The MEB orthopedic addendum was dated 3 September 2003.  The CI reported neck pain and headaches while wearing his Kevlar and flight helmet.  His shoulder symptoms were nearly resolved after the surgery 6 months prior.  On examination, he had paraspinal tenderness and a normal ROM.  Motor and reflex examinations were normal.  The sensory examination was not recorded.  The narrative summary was dated 6 October 2003, 6 months prior to separation.  It essentially duplicated the orthopedic addendum.  At the VA Compensation and Pension (C&P) examination performed on 9 July 2004, approximately 3 months after separation, the CI reported constant neck pain with radiation to both upper extremities.  He denied incapacitation or time lost from work from the neck pain.  On examination, posture and gait were normal.  The ROM was painful in all directions and limited as charted below.  Repetition increased the pain, but additional limitation in motion was not recorded.  The neurological examination was normal and atrophy was absent.  The goniometric 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)

MEB ~ 6 Mo. Pre-Sep

VA C&P ~ 3 Mo. Post-Sep

Flex (45 Normal) | Normal ROM | 45
Combined (340) | | 260
Comment | No spasm.  Tenderness | Painful motion
§4.71a Rating | 10% | 10%

The Board directed attention to its rating recommendation based on the above evidence.  The PEB and VA both rated the neck at 10% using the analogous code 5299-5237 (cervical strain).  The Board considered the evidence and 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.

Chronic Low Back Pain…MRI denotes Degenerative Disc Disease.  The first record in evidence regarding the LBP was dated 10 May 2001.  The CI reported a day’s history of pain without recorded antecedent trauma.  He was treated with stretching, medications, and physical therapy, but continued to have LBP.  An MRI on 24 July 2002 showed a herniated disc at L5-S1 with possible impingement of the S1 nerve root.  An aviation medicine note date 19 November 2002 documented a normal neurological examination and FROM (full range-of-motion).  However, on 8 August 2003, he was noted to have an antalgic gait (one that guards against pain) and reduced ROM in all planes.  X-rays on 3 September 2003 were normal.  The MEB orthopedic addendum, 7 months prior to separation, noted occasional numbness and tingling to his mid calves.  On examination, he had a normal ROM, strength, and reflexes.  A physical medicine evaluation on 5 March 2004, 3 weeks prior to separation, noted painful motion of the back at the end of the range, but normal motion and a normal neurological examination.  At the VA C&P examination, 3 months after separation, the CI reported that the LBP radiated to the left lower extremity.  His daily activities were unrestricted except for pushing a lawn mower.  On examination, his gait was normal and steady.  The posture was normal.  There was spasm at L4-5 and L5-S1.  However, there was no tenderness to palpation.  The ROM was limited to the onset of pain and is charted below.  Repetition increased his pain, but did not further limit the ROM.  The neurological examination was normal.  Atrophy was absent.  The goniometric 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.

Thoracolumbar ROM
(Degrees)

MEB ~ 6 Mo. Pre-Sep

VA C&P ~ 3 Mo. Post-Sep

Flexion (90 Normal) | Normal ROM | 55
Combined (240) | | 185
Comment | Normal Neurological examination; tenderness | Paraspinal spasm at L4-5 L5-S1.  Nml gait, posture, neurological examination
§4.71a Rating | 10% | 20%

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the back at 10% using the analogous code 5299-5237 (lumbo-sacral strain).  The VA rated the back at 20%, citing the C&P ROM values, and used the code 5299-5243 (intervertebral disc syndrome).  The Board considered the evidence.  The MEB and physical medicine examination, 6 months and 3 weeks prior to separation, respectively, both recorded a normal ROM and neurological examination.  The VA C&P examination documented limited flexion, but a normal gait and posture.  The latter findings are not consistent with the reduced ROM.  The Board noted that the limitation in motion was identical to the onset of pain and opined that these measurements may not, therefore, actually reflect the actual limit in motion.  In consideration to the totality of evidence, the Board therefore assigned a higher probative value to the ROMs obtained prior to separation, and noted also that these were by an orthopedist and physiatrist, respectively.  The neurological examination on MEB examination, the physical medicine examination 3 weeks prior to separation, and the VA C&P examination were all normal.  The evidence does not support the presence of an unfitting neuropathy at separation.  Therefore, the Board concluded that this condition could not be recommended for additional disability 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 back condition.

Contended PEB Conditions.  The CI also contended for the not unfitting cervical radiculopathy.  The Board’s main charge is to assess the fairness of the PEB’s determination that this condition was not unfitting.  The Board’s threshold for countering fitness determinations requires a preponderance of evidence, but remains adherent to the DoDI 6040.44 “fair and equitable” standard.  The radiculopathy was not implicated in the commander’s statement, but it was profiled and judged to fail retention standards.  An EDX showed a chronic right C-6 radiculopathy.  However, review of the record shows that the neurological examination was normal on the MEB and C&P examination which bracket separation.  Also, there was no muscle atrophy.  The CI denied lost duty time from the neck condition at the VA C&P examination.  The radiculopathy condition was reviewed and considered by the Board.  There was no performance based evidence from the record that it 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 radiculopathy condition and so no additional disability rating is 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.  In the matter of the back condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended C-6 radiculopathy condition, the Board unanimously agrees that it cannot recommend it for additional disability rating.  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 20140508, 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 XXXXXXXXXXXXXXXXXXXX, AR20150014212 (PD201402147)

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

PD-2014-02147