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AF | PDBR | CY2013 | PD-2013-02757
Original file (PD-2013-02757.rtf) Auto-classification: Approved
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXX   CASE: PD-2013-02757
BRANCH OF SERVICE: Army  BOARD DATE: 20150123
SEPARATION DATE: 20060421


SUMMARY OF CASE: Data prescription extracted from the available evidence of record reflects that this covered individual (CI) was National Guard E-4 (Petroleum Supply Specialist) medically separated for neck pain. The neck condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty; however, his profile indicated he could take an alternate physical training test. He was issued a permanent U3 profile and referred for a Medical Evaluation Board (MEB). The neck pain condition, characterized as “cervicalgia,” was the only condition forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. The Informal PEB adjudicated “chronic neck pain without neurologic abnormality” as unfitting, rated 10%, citing passive range of motion with likely application of AR 635-40. The CI made no appeals and was medically separated.


CI CONTENTION: “The VA did not take into full consideration how these disabilities will affect my life. I constantly struggle with daily activities and daily severe pain located in my neck and upper shoulder areas.”


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 20060411
 VA - (Same month as Separation)
Condition
 Code Rating Condition Code Rating Exam
Chronic Neck Pain Without Neurologic Abnormality 5299-5237 10% Chronic Neck Strain (Claimed as C3-4 and C4-5 Bulging Discs) 5237 10% 20060405
Other x 0 (Not in Scope)
 Other x 0 20060405
Combined: 10%
 Combined: 10%
Derived from VA Rating Decision (VA RD ) dated 200 60503 ( most proximate to date of separation [ DOS ] ).

ANALYSIS SUMMARY:

Neck Condition. The CI sustained a whiplash injury from a motor vehicle accident while deployed to New Orleans in October 2005. A month later a basketball goal fell on his head. Neck strain and later cervicalgia (pain in the neck due to muscle strain or ligament sprain) was diagnosed. Conservative treatment did not relieve the neck pain. X-rays of the cervical spine were normal except for anterior superior spurs at C5. Magnetic resonance imaging of the cervical spine revealed bulging at C3-C4 and C4-C5. There were no indications for surgical intervention. Pain management with a transcutaneous electrical nerve stimulation unit and cervical traction did not relieve the pain. He received a U3 profile for persistent neck pain. The commander’s statement dated 9 March 2006 noted the CI was physically incapable of performing his duties due to his persistent neck pain. The narrative summary dated 13 March 2006, noted the CI was unable to perform activities like lifting and carrying heavy equipment. He could perform the basic activities of daily living but was unable to play basketball or football because of neck pain. The physical exam noted a normal gait and no muscle atrophy or spasm of the paraspinal muscles. There were no neurological deficits and no radicular signs. Deep tendon reflexes were 2 out of 4 (normal). Muscle strength and coordination were good. He reported discomfort on forward flexion as well as extension and right rotation of the cervical spine. Range-of-motion (ROM) testing revealed active forward flexion at 25 degrees (normal 45), combined 235 degrees (normal 340 degrees). Contour of the cervical spine was not addressed. The physical therapy (PT) examination dated 14 March 2006, noted the CI tolerated ROM with minimal discomfort. Sensation was intact in the upper extremity. Muscle strength was 5 out of 5. Although there was mild discomfort in the neck there was no change in facial expressions. Bicep and radial reflexes were 1 out of 5 bilaterally and triceps was 0 out of 5 bilaterally. ROM measurements were an average of three measurements: Active forward flexion was 25 degrees (normal 45), combined 245 degrees (normal 340 degrees) [passive as 45 flexion/310 combined]. The exam was silent regarding muscle spasm, guarding, or contour of the cervical spine.

The VA Compensation and Pension (C&P) exam, dated 5 April 2006, performed approximately 15 days prior to separation, was not in evidence. The VARD, dated 30 May 2006, referenced the C&P exam and noted the CI experienced pain in his neck upon testing and the ROM of his cervical spine, in flexion, was 35 degrees. The ROM was not limited by fatigue, weakness, lack of endurance, or incoordination. The VARD assigned a disability rating of 10% for chronic neck strain. Remote VA exam in 2009 documented more limited ROMs with an increased rating of 30 percent effective February 2009. There was a subsequent VA exam and rating decrease to 20 percent in April 2010.

The Board directed attention to its rating recommendation based on the above evidence. The PEB assigned a 10% rating under the 5299-5237 code citing a combined ROM of 310 degrees. The source PT exam documented passive ROMs of 45 degrees flexion and 310 degrees combined. However, the active ROM (used in the VASRD ratings) from that exam was 245 degrees combined and 25 degrees of forward flexion. The PEB likely applied the guidance of AR 635-40, B-29 to consider only a mechanical basis for restricted motion. The VA rated the condition 10%, coded 5237 based on an exam not in evidence and only sparsely summarized in the VARD. Under the VASRD rating formula for the spine, a 20% rating is warranted for forward flexion greater than 15 degrees but not greater than 30 degrees; combined range of motion not greater than 170 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour. The ROM on the PT and MEB exams supported a 20% rating, but the VA exam’s flexion, as referenced by the VARD, warranted 10%.

The Board also considered rating intervertebral disc disease under the alternative formula for incapacitating episodes, but could not find sufficient evidence which would meet the criteria for a minimal rating under that formula. The VA exam was not in evidence and the VARD only referenced forward flexion measures and was incomplete. Therefore, the Board considered the PT and MEB exams to be more probative. The 25 degrees of flexion noted on both exams supported a disability rating of 20%. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 20% for the chronic neck pain condition.

The Board finally deliberated if additional disability was justified for peripheral nerve impairment. There were no complaints of muscle problems numbness, or shooting pain into the arms and hands, and muscle strength was normal. The presence of functional impairment with a direct impact on fitness is the key determinant in the Board’s decision to recommend any condition for rating as additionally unfitting. There is no evidence in this case of functional impairment attributable to peripheral neuropathy. The Board therefore concluded that additional disability was not justified on this basis.


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. As discussed above, PEB reliance on AR 635-40 for rating the neck condition was likely operant in this case and the condition was adjudicated independently of that instruction by this Board. In the matter of the chronic neck pain condition, the Board unanimously recommends a disability rating of 20%, coded 5237 IAW VASRD §4.71a. There were no other conditions within the Board’s scope of review for consideration.


RECOMMENDATION: The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation:

UNFITTING CONDITION VASRD CODE RATING
Chronic Neck Pain Without Neurologic Abnormality Condition 5299-5237 20%
COMBINED 20%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20131216, 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, AR20150008491 (PD201302757)


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 Board’s recommendation to modify the individual’s disability rating to 20% without recharacterization of the individual’s 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                       XXXXXXXXXXXXXXX
                           Deputy Assistant Secretary of the Army
                           (Review Boards)

CF:
( ) DoD PDBR
( ) DVA

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