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AF | PDBR | CY2014 | PD-2014-00749
Original file (PD-2014-00749.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX          CASE : PD -20 1 4 - 00749
BRANCH OF SERVICE: Army   BOARD DATE: 201 4 0805
Separation Date: 20051117


SUMMARY OF CASE : Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SFC/E-7 (37F40/ Psychological Operations Specialist) medically separated for chronic neck and shoulder pain. The neck and shoulder 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 referred for a Medical Evaluation Board (MEB). The neck and shoulder condition, characterized as “neck pain and myofascial syndrome with facette degeneration” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. No other conditions were submitted by the MEB. The Informal PEB adjudicated “chronic neck and shoulder pain due to myofascial pain syndrome and C7 facet degeneration” as unfitting, rated 10%. The CI made no appeals and was medically separated.


CI CONTENTION : The CI elaborated no specific contention in his application.


 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 neck and shoulder pain due to myofascial pain syndrome and C7 facet degeneration is addressed below; no additional conditions are within the DoDI 6040.44 defined purview of the Board. 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 :
invalid font number 31502
Service IPEB – Dated 20050728
 VA - (3 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Chronic Neck & Shoulder Pain due to Myofascial Pain Syndrome & C7 Facet Degeneration 5237 10% Cervical Strain w/ Myofascial Pain Syndrome 5323-5237 10% 20060228
Other x 0 (Not in Scope)
 Other x 2
Rating: 10%
 Combined Rating: 20%
Derived from VA Rating Decision (VARD) dated 20060427 (most proximate to date of separation [DOS]) invalid font number 31502

ANALYSIS SUMMARY :

Chronic Neck and Shoulder Pain Condition. The CI had a history of neck pain dating back to 1998 when he was injured in a parachute jump. In late 2002 and early 2003, the CI presented with neck and shoulder pain due to wearing a flak vest, helmet, and web gear for extended periods of time while deployed. He was diagnosed with cervicalgia and possible cervical facet disorder. He was pending another deployment but had a temporary U3 profile. He was initially treated conservatively and underwent radiofrequency denervation (a procedure that interrupts a nerve fiber's ability to carry pain messages to the brain) treatment. He was seen on 9 January 2003, in follow-up with his Family Practice provider who noted some improvement. A cervical spine X-ray in April 2003 was normal. The CI was referred to physical therapy (PT) in May 2003 for an increase in shoulder girdle and right hand pain and was diagnosed with chronic neck pain. He was evaluated by Physical Medicine in July 2003 for complaints of numbness in his arms while at parade rest after a minute and neck pain after wearing his protective gear. The physical exam findings were normal. An electromyogram (EMG) performed in August 2003 demonstrated chronic changes in the right upper extremity. A cervical spine magnetic resonance imaging (MRI) also showed mild, early degenerative changes and minimal para-central disc bulging on the right at C3-4 with mild foraminal stenosis and minimal broad-based disc bulging C6-7 without any disc herniation. The Pain Management examiner documented physical exam findings of range-of-motion (ROM) with pain on extension and lateral rotation and tenderness to palpation over C6-7 with some radiation of pain; motor and sensory were intact and reflexes were normal. He was then seen by Orthopedics who noted cervical pain and radiculopathy but normal strength and sensation in the upper extremities. The CI continued with complaints of numbness in both arms due to facet degeneration in the cervical spine throughout the remainder of 2003 and into 2004. Nevertheless, he was deployed to Iraq in 2004 despite his condition. He was seen repeatedly in-theater for his condition beginning in March 2004 and was medically evacuated out of theater back to his home station in November 2004. A repeat cervical spine MRI performed in November 2004 showed right greater than left foraminal narrowing at C3-4 and left greater than right foraminal narrowing at C4-5 due to lateral disc bulges and mild facet hypertrophy. A repeat EMG and a nerve conduction velocity test in December 2004 were both normal. The CI was seen back in the Pain Management Clinic and underwent five trigger point injections into the neck muscles and trapezius muscles which were first administered in January 2005. The CI was given a permanent U3 profile in March 2005 for myofascial pain syndrome and C7 facet degeneration. The commander’s statement dated 5 April 2005 documented that the CI had to compensate for the neck and shoulder pain and weakness by making slow deliberate movements, which were especially noticeable when walking, lifting, and driving, and interfered with fully functioning within his MOS. The MEB narrative summary (NARSUM) exam performed on 11 May 2005, approximately 6.5 half months prior to separation, documented neck and shoulder pain and noted that the CI underwent multiple injections to the facette joint in the spine, had had Botox injections, and cervical traction. The examiner further documented that the CI had achieved the maximum in conservative care for this condition without a positive result. Both neurosurgery and orthopedics examined the CI and neither recommended surgical intervention. The CI was evaluated by PT on 18 May 2005, approximately 6 months prior to separation, to conduct ROM measurements for the MEB NARSUM exam. The VA Compensation and Pension (C&P) exam on 28 February 2006, approximately 3.5 half months after separation, documented that the CI was currently employed as an instructor. He had one day of incapacitating pain in the past year; however, he did experience flare-ups and pain could wake him up during the night at times. He continued with myofascial pain in the cervical trapezius muscle areas.

The Board directs attenti on to its rating recommendation based on the above evidence . The PEB coded the chronic neck and shoulder pain due to myofascial pain syndrome and C7 facet degeneration condition 5237 ( l umbosacral or cervical strain ) and rated i t 10%. The VA applied a combination code of 5323 ( Group XXIII M uscle Function ) with 5237 and rated i t 10% citing cervical spine ROM measurements. The General Rating Formula for Diseases and Injuries of the Spine includes “With or without symptoms such as pain (whether or not it radiates), stiffness or aching in the area of the spine affected by residuals of injury or disease.” All exams proximate to separation document that t he CI met the cervical spine 10% rating criteria for “ combined range - of - motion of the cervical spine greater than 170 degrees but not greater than 335 degrees. ” Board precedent is that a functional impairment tied to fitness is required to support a recommendation for addition of a peripheral nerve rating at separation. The pain component of a radiculopathy is subsumed under the general spine rating as specified in §4.71a. The sensory component in this case has no functional implications. An EMG was performed and did not implicate any motor nerve involvement. Since no evidence of functional impairment exists in this case, the Board cannot support a recommendation for additional rating based on peripheral nerve impairment. 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 and shoulder pain .


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 c hronic n eck and s houlder p ain due to m yofascial p ain s yndrome and C7 f acet d egeneration 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 re - characterization of the CI’s disability and separation determination.


The following documentary evidence was considered:
Exhibit A. DD Form 294, dated 20 140210 , w/atchs
Exhib it B. Service Treatment Record
Exhibit C. Department of Veterans ’ Affairs Treatment Record








                          
XXXXXXXXXXXXXXXXXX
President
Physical Disability Board of Review
invalid font number 31502


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 XXXXXXXXXXXXXXXXXX AR20150007054 (PD201400749)

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

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