RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW
NAME: XXXXXXXXXXXXXXXX CASE: PD 13-00015
BRANCH OF SERVICE: ARMY BOARD DATE: 20130503
SEPARATION DATE: 20030723
SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this
covered individual (CI) was an active duty SGT/E-5 (11B, Infantry) medically separated for
chronic neck pain. The CI injured his neck in March 2000, while riding in a military truck that lost
contact with the road. Conservative measures, including physical therapy (PT), failed to relieve
his pain. The neck 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-H2 profile and referred for a Medical Evaluation Board (MEB).
The neck condition, was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.
Several other conditions, identified below, were also submitted by the MEB. The informal PEB
adjudicated the chronic neck pain as unfitting, rated 10%, citing criteria of the Veterans
Administration Schedule for Rating Disabilities (VASRD). The CI made no appeals, and was
medically separated with a 10% Service disability rating.
CI CONTENTION: I feel that my cervical spine injury was rated low in an effort to prevent
medical retirement. And my other injuries ignored completely as an injustice. I incurred several
injuries and conditions that should have been considered and rated under the VASRD, and in
accordance with Title I0, Section 1222, I repeatedly requested these conditions be included and
rated, but was ignored and instructed to only focus on my cervical spine.
SCOPE OF REVIEW: The Boards 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. Ratings for unfitting conditions will be reviewed
in all cases. The unfitting chronic neck pain condition meets the criteria prescribed in DoDI
6040.44 for Board purview. The back pain, headaches, knee pain, ankle pain, hearing loss, and
aortic insufficiency are likewise addressed below. Any conditions not requested in his
application, or otherwise outside the Boards defined scope of review, may be eligible for future
consideration by the Army Board for Correction of Military Records.
RATING COMPARISON:
Service IPEB Dated 20030401
VA (1 mo. Pre-Separation)
Condition
Code
Rating
Condition
Code
Rating
Exam
Chronic Neck Pain
5299-5295
10%
Disc Disease of Cervical Spine,
with Episodic Ulnar Radiculitis
and Cervicogenic Cephalgia
5290
20%
20030602
Back Pain
Not Unfitting
Episodic Lumbosacral Strain
5295
0%
20030602
Headaches
Not Unfitting
No VA Entry for Headaches
Bilateral Knee Pain
Not Unfitting
Bilateral Overuse Knees
5024
0%
20039692
Bilateral Ankle Pain
Not Unfitting
Ligamentous Laxity, Both Ankles
5299-5271
0%
20030602
Left Ear Hearing Loss
Not Unfitting
Bilateral Hearing Loss
6100
0%
20030602
Mild Aortic Insufficiency
Not Unfitting
Aortic Insufficiency
7199-7110
NSC
20060602
No Additional MEB/PEB Entries
Other x 4
20030602
Combined: 10%
Combined: 20%
Derived from VA Rating Decision (VARD) dated 20030728(most proximate to date of separation)
ANALYSIS SUMMARY: The Board acknowledges the CIs assertion that certain improprieties
may have occurred while the Army was processing his case. It is noted for the record that the
Board has neither the jurisdiction nor authority to scrutinize or render opinions in regard to
suspected Service improprieties. The Boards role is confined to the review of medical records
and all evidence at hand to assess the fairness of PEB fitness and rating determinations, based
on severity at the time of separation.
Chronic Neck Pain. In March 2000, the CI developed symptoms after a very rough truck ride.
His symptoms included neck pain and headache, as well as numbness of the right hand and left
shoulder. Magnetic resonance imaging (MRI) revealed cervical degenerative disc disease
(DDD), with evidence of cervical spinal stenosis (CSS) and mild to moderate foraminal
narrowing. He was treated with conservative measures, but had very little improvement. The
CI was not a surgical candidate, and an MEB was initiated. His MEB clinical evaluation was at
Madigan Army Medical Center on 7 February 2003. Physical examination (PE) revealed a heart
murmur and alopecia (hair loss), but was otherwise unremarkable. On 27 February 2003, the CI
was seen by Neurosurgery. The examiner stated, The patient, at no time, has had evidence of
radiculopathy. PE showed intact deep tendon reflexes (DTRs), with no focal motor weakness
in the extremities. Range of motion (ROM) testing showed that lateral turning was intact (60
degrees), and neck flexion was 45 degrees. The diagnosis at that visit was Chronic neck pain
related to C5-C6 cervical disc protrusion.
On 2 June 2003, seven weeks prior to separation, the CI had a VA compensation and pension
(C&P) exam. He reported daily neck pain which was aggravated by lifting heavy objects or
prolonged standing. He also reported some loss of sensation and occasional weakness in the
right upper extremity. PE revealed normal gait and normal spinal curvature. No muscle spasm
was noted. There was mild tenderness to palpation of the cervical and mid-thoracic regions.
Cervical ROM testing showed flexion of 50 degrees, extension 60 degrees, lateral bending 30
degrees (left & right), and rotation 80 degrees (left & right). All motions produced mild
discomfort in the cervical spine. Neurological exam was normal. The ROM evaluations which
the Board weighed in arriving at its rating recommendation, are summarized in the chart below.
Cervical ROM
MEB ~ 5 mos. Pre-Sep
(20030227)
VA C&P ~ 2 mos. Pre-Sep
(20030602)
Flexion
45°
50°
Extension
(not noted)
60°
Right Lat. Flexion
(not noted)
30°
Left Lat. Flexion
(not noted)
30°
Right Rotation
60°
80°
Left Rotation
60°
80°
The Board carefully reviewed all evidentiary information available, and directs attention to its
rating recommendation based on the above evidence. The PEB and the VA chose different
coding and rating options for the chronic neck pain condition. The PEB coded it 5299-5295
(analogous to lumbosacral strain) and rated it 10% for characteristic pain on motion. The VA
used diagnostic code 5290 (limitation of cervical motion) and rated it 20% (moderate). The
Veterans Administration Schedule for Rating Disabilities (VASRD) coding and rating standards
for the spine, which were in effect at the time of the CIs separation, were changed in
September 2003. The older standards were based on the raters opinion regarding degree of
severity, whereas current standards specify certain rating thresholds, with measured degrees of
ROM impairment. IAW DoDI 6040.44, the Board must use the VASRD coding and rating
standards which were in effect at the time of the CIs separation from service.
The June 2003 C&P exam was done just seven weeks prior to separation, and therefore carries
significant probative value. At that exam, the CI had limited lateral flexion to the right and to
the left. Based on the evidence in the treatment record, the Board unanimously agreed that
the VASRD code which most closely aligns with limited cervical motion is 5290 (Spine, limitation
of cervical motion). The Board also determined that the CIs chronic neck pain condition was
best described as slight. There was insufficient evidence in the treatment record to support
classifying the chronic neck pain condition as moderate or severe. IAW VASRD §4.71a, the
Board unanimously recommends a rating of 10% for the chronic neck pain condition. The
Board tried to find a path to a higher rating using other codes which could be applied to the
chronic neck pain condition. The other VASRD codes that were considered did not result in a
higher rating, since the treatment record did not show evidence of a significantly disabling neck
abnormality which would justify a rating higher than 10%.
The Board also considered the matter of cervical radiculopathy. As noted above, The June 2003
VA C&P exam was the exam most proximal to separation. On that evaluation, neurological
exam was essentially normal. The CIs radiculopathy symptoms were purely subjective. After
reviewing all of the information in the treatment record, there was insufficient objective
evidence of a clinically significant neuropathy that interfered with satisfactory performance of
military duties. Therefore, the radiculopathy condition was not unfitting at the time of
separation from service. After due deliberation, considering all of the evidence and mindful of
VASRD §4.3 (reasonable doubt), the Board unanimously recommends a disability rating of 10%
for the chronic neck pain condition. It is appropriately coded 5290, and IAW VASRD §4.71a,
meets criteria for the 10% rating level.
Other PEB Conditions. Back pain, headaches, bilateral knee pain, bilateral ankle pain, hearing
loss, and aortic insuffiency were all adjudicated by the PEB as not unfitting and therefore not
ratable. The Boards main charge with regard to these conditions is to assess the fairness of the
PEBs fitness determination. The Boards 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. These other
conditions were not profiled, implicated in the commanders statement, or 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 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 these other conditions.
Therefore, 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. In the matter of the
chronic neck pain condition and IAW VASRD §4.71a, the Board unanimously recommends a
disability rating of 10% for the chronic neck pain condition. In the matter of the back pain,
headaches, knee pain, ankle pain, hearing loss, and aortic insuffiency; the Board unanimously
recommends no change in the PEB adjudication as not unfitting. There were no other
conditions within the Boards scope of review for consideration.
RECOMMENDATION: The Board recommends that the CIs prior determination be modified as
follows, effective as of the date of his prior medical separation:
UNFITTING CONDITION
VASRD CODE
RATING
Chronic neck pain, and slightly reduced range of motion
5290
10%
COMBINED
10%
The following documentary evidence was considered:
Exhibit A. DD Form 294, dated 20130105, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans Affairs Treatment Record
xxxxxxxxxxxxxxxxxxxx, DAF
Acting Director
Physical Disability Board of Review
SFMR-RB
MEMORANDUM FOR Commander, US Army Physical Disability Agency
(TAPD-ZB / xxxxxxxxxxxx), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557
SUBJECT: Department of Defense Physical Disability Board of Review Recommendation
for xxxxxxxxxxxxxxxxxxxxxxxx, AR20130011069 (PD201300015)
1. 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 Boards
recommendation to modify the individuals disability description without modification of the
combined rating or recharacterization of the individuals separation. This decision is final.
2. I direct that all the Department of the Army records of the individual concerned be corrected
accordingly no later than 120 days from the date of this memorandum.
3. I request that a copy of the corrections and any related correspondence be provided to the
individual concerned, counsel (if any), any Members of Congress who have shown interest, and
to the Army Review Boards Agency with a copy of this memorandum without enclosures.
BY ORDER OF THE SECRETARY OF THE ARMY:
Encl xxxxxxxxxxxxxxxxxxxxxxx
Deputy Assistant Secretary
(Army Review Boards)
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