RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXX	CASE:  PD-2013-00175
BRANCH OF SERVICE:  Army	BOARD DATE:  20140828
SEPARATION DATE:  20050809

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (88M/Truck Driver) medically separated for neck and shoulder pain.  The neck and shoulder pains could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS).  He was issued a permanent U3 profile and referred for a Medical Evaluation Board (MEB).  His profile allowed for an alternate aerobic event to satisfy physical fitness standards.  “Chronic neck and shoulder pains status post (s/p) cervical diskectomy, osteophytectomy, decompression of spine cord, C6-7,” was forwarded to the Physical Evaluation Board (PEB) in accordance with (IAW) AR 40-501.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated “neck and shoulder pain with normal electromyogram (EMG) and a magnetic resonance imaging finding of large central disc extrusion at C6/C7 causing mild cervical compression” as unfitting, rated 10%, with likely application of the VA Schedule for Rating Disabilities (VASRD).  The CI appealed to the Formal PEB (FPEB) which affirmed the Informal PEB (IPEB) findings and rating.  The CI was medically separated.

CI CONTENTION:  “Member was only rated for neck pain, not properly evaluated for PTSD, Depression and Anxiety from deployment and military service.”

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 is addressed below; and, no additional conditions are within the DoDI 6040.44 defined purview of the Board.  The contended posttraumatic stress disorder, depression and anxiety conditions were not identified by the MEB/PEB, and thus are not 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:

Service FPEB – Dated 20050506	VA - (2 Mos. Pre-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Neck and Shoulder Pain…with cervical fusion	5241	10%	Residuals of Anterior Cervical Fusion with Scar	5241	10%	20050616	
Rating:  10%	Combined Rating:  40%	
Derived from VA Rating Decision (VARD) dated 20051024 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Neck and Shoulder Condition.  The CI first reported symptoms of neck and shoulder pain after a parachute landing fall in gusty conditions at jump school in November 2002.  He began to notice paresthesia’s (numbness and tingling) in his hands and shoulders while running, which resolved with rest; later, he noticed paresthesia’s and pain while standing in formation.  Originally diagnosed with carpal tunnel syndrome or thoracic outlet syndrome, conservative treatment resulted in no improvement in symptoms.  He was placed on temporary profile in November 2003, an EMG in March 2004 was normal, but radiographic imaging in April 2004 (16 months prior to separation) revealed a large cervical central disc herniation.  He underwent cervical discectomy (removal of disc), which decompressed the spinal cord and fusion of cervical vertebrae C6 and C7.  The CI reported no improvement in pain and additionally described parasthesias in both upper and lower extremities.  A permanent profile (U3) 6 months prior to separation severely limited physical activities, including wearing of helmet or Kevlar.  The commander’s memorandum to the MEB supported the CI’s “release from duty,” noting that the CI was precluded by his profile “from normal duties” and was only performing duties which did “not require much physical exertion.”

On the DD Form 2697, Report of Medical Assessment, completed prior to the MEB, the CI noted neck and back pain, with “numbness in legs and arms.”  At the MEB exam, the CI reported constant pain with parasthesias in upper and lower extremities.  The MEB physical exam noted stiff neck and shoulders, without tenderness to palpation (TTP), but with limitation of motion secondary to pain.  Full strength (5/5), without weakness, was noted in the extremities, with intact sensation and absence of muscle atrophy.

The narrative summary (NARSUM) noted “neck and shoulder pains,” with “constant daily pain” (6/10), worse upon awakening (up to 8/10), with symptoms worsened by activities at work, such as bending, prolonged sitting and getting into a truck.  The NARSUM added that the pain affected activities of daily living, including carrying groceries and lifting his children, noting that the CI used “two hands to pick up a cup of coffee or it would fall if he uses one hand.”  The CI was unable to perform the duties of his MOS, to build a fighting position or to carry or fire a weapon.  On the physical examination, the NARSUM noted a well-healed scar, limited neck motion due to pain, but “no limitation of movement” of upper extremities, without weakness, including both shoulders.  The neck was non-tender and tenderness of the shoulders was not noted.

The MEB (6 months prior to separation) forwarded the diagnosis of chronic neck and shoulder pain, s/p surgery, as medically unacceptable.  The IPEB (5 months prior to separation) adjudicated that the neck and shoulder condition was unfitting, noting normal EMG and full strength, but with decreased cervical range-of-motion (ROM) due to pain.  The CI did not concur and requested an FPEB which affirmed the IPEB results.

At the VA Compensation and Pension (C&P) examination, dated 2 months prior to separation, the CI reported neck pain (7/10), sharp, cramping, squeezing, crushing, “radiating to shoulders,” elicited by physical activity and stress, relieved with medication.  The pain did not cause incapacitation, but limited the CI’s ability to lift, to sleep and to perform upper body exercise.  The CI also noted loss of strength in the hands, arms, shoulders and neck and constant numbness in the hands, shoulders and feet, which affect his ability to lift, carry and exercise.  The CI noted that due to these limitations he was employed doing light desk work.  The C&P physical examination documented TTP of the cervical spine with normal posture and gait, without ankylosis, muscle spasm or radiating pain on movement.

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)	
PT/MEB ~ 6 Mo. Pre-Sep
	
VA C&P ~ 2 Mo. Pre-Sep
	
Flex (45 Normal)	45 	40	
Extension (45)	45 	40	
R Lat Flexion (45)	35 	40	
L Lat Flexion (45)	30 	40	
R Rotation (80)	80 	70	
L Rotation (80)	60 	70	
Combined (340)	295	300	
Comment	Neck non-tender, cervical motion limited by pain. Normal strength and sensation in extremities.	Normal gait and posture, no spasm or guarding, limited by pain after repetitive use. Normal strength and sensation in extremities.	
§4.71a Rating	10%	10%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the condition at 10% under VASRD code 5241 (spinal fusion), IAW the VASRD General Rating Formula for Diseases and Injuries of the Spine, due to limitation of combined ROM “of the cervical spine greater than 170 degrees but not greater than 335 degrees.”  The VARD, dated 3 months after separation, rated the condition at 10%, citing limitation of cervical flexion and limitation of cervical combined ROM of 300 degrees.  The criteria for the next higher rating (20%), which includes limitation of cervical flexion to 30 degrees or less, combined ROM of 170 degrees or less, or muscle spasm or guarding sever enough to result in an abnormal gait or abnormal contour, were not met in this case.

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 condition.

Peripheral neuropathy:  The Board considered whether an additional rating could be recommended under a peripheral nerve code for radiculopathy at separation.  The pain component of the neuropathy is appropriately subsumed in the spine rating and the sensory component was inconsequential to fitness.  The Board members deliberated whether the CI’s subjective motor weakness in evidence impacted fitness to an extent that would justify a separate rating.  The weakness was not evident on physical examination or in radiological or EMG evidence.  The VARD, based upon the C&P examination (6 weeks prior to separation) also documented “no left or right arm numbness” and “strength is equal and normal in both upper extremities” with three normal EMG studies.  The Board concluded that the CI’s radiating pain and paresthesia’s do not constitute a separately unfitting diagnosis and therefore does not warrant an additional disability rating.

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 and shoulder pain 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 20130415, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

		
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 XXXXXXXXXXXXXXXXX, AR20150006399 (PD201300175)

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						     
						         
CF: 
(  ) DoD PDBR
(  ) DVA