RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2013-01287
BRANCH OF SERVICE:  Army	BOARD DATE:  20150115
SEPARATION DATE:  20050308

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated National Guard E-4 (Motor Transport Operator) medically separated for neck pain.  The condition 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 P3/U3 profile and referred for a Medical Evaluation Board (MEB).  “Cervicalgia, sleep apnea, and diabetes mellitus, type II” were forwarded to the Physical Evaluation Board (PEB) as medically unacceptable IAW AR 40-501.  No other condition was submitted by the MEB.  The Informal PEB adjudicated “neck pain secondary to falling off a truck” as unfitting, rated 20%, with likely application of the VA Schedule for Rating Disabilities (VASRD).  The remaining conditions were determined to be not unfitting.  The CI made no appeals and was medically separated.

CI CONTENTION:  The CI elaborated no specific contention in his application, but simply listed two conditions:  cervical strain and patellofemoral syndrome, left knee.

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 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 20041223 	VA* - (~2 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Neck Pain	5237	20%	Cervical Strain	5237	20%	20050519	
Other x 2 (Not In Scope)	Other x 13	
RATING:  20%	RATING:  40%	
*Derived from VA Rating Decision (VARD) dated 20050708 (most proximate to date of separation (DOS))

ANALYSIS SUMMARY:

Painful Neck Condition.  The narrative summary (NARSUM) noted the CI developed neck pain and tingling in his left arm after falling off a truck in June 2003.  A magnetic resonance imaging obtained in August 2003, revealed minimal degenerative changes in the spine bones of the lower neck.  A nerve conduction study, obtained on 6 August 2003, showed no evidence of spinal neuropathy.  An examination at that time showed “full flexion of the cervical spine” and normal motor strength and reflexes in the upper extremities.  A physical therapy (PT) evaluation for the MEB was obtained on 5 February 2004 approximately 13 months prior to separation; results are summarized in the chart below.  At a PT evaluation on 30 June 2004 approximately 8 months prior to separation, motor strength and reflexes in the arms were noted to be normal.  At the MEB/NARSUM evaluation on 29 November 2004, 4 months prior to separation, physical exam noted tenderness to palpation in the lower neck.  Motor, sensory and reflex exams were normal.  The examiner referenced the range-of-motion (ROM) findings of PT evaluation conducted on 5 February 2004 as noted below.

At the VA Compensation and Pension exam performed 2 months after separation, the CI reported neck pain radiating down his left arm.  The results of the physical exam are summarized in the chart below.

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.

Active Cervical ROM
(Degrees)	MEB ~13 Mo. Pre-Sep
(20040205)	VA C&P ~2 Mo. Post-Sep
(20050519)	
Flex (45 Normal)	45 (50,50,52)	30	
Extension (45)	20 (22,20,20)	10	
R Lat Flexion (45)	35 (38,35,35)	5	
L Lat Flexion (45)	35 (30,32,33)	30	
R Rotation (80)	45 (45,45,45)	10	
L Rotation (80)	45 (45,50,45)	40	
Combined (340)	225	125	
Comment	No painful motion noted	Painful motion; 
Neurologic exam normal	
§4.71a Rating	10%	20%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB and the VA both rated the neck condition 20%, code 5237 (cervical strain).  The PEB cited a passive flexion cervical ROM of 60 degrees; and the VA cited an active flexion cervical ROM of 30 degrees.  Under this code, IAW §4.71a, a rating of 10% requires forward flexion of the cervical spine greater than 30 degrees, but not greater than 60 degrees.  The next higher rating, 20%, requires flexion of the cervical spine greater than 15 degrees, but not greater than 30 degrees.  The next higher rating, 40%, requires flexion of the cervical spine of 15 degrees or less.  The Board agreed that the evidence in the record, supported a rating of 20%, but no higher, for decreased ROM of the cervical spine IAW §4.71a.  The Board considered a rating IAW §4.124 (neuralgia, peripheral nerve).  The Board agreed there was no ratable peripheral nerve impairment in this case, since the preponderance of evidence in record showed that no motor weakness was present, sensory symptoms had no functional implication and nerve conduction studies were normal.  The Board considered a rating under code 5243 (incapacitating episodes/intervertebral disc syndrome).  An incapacitating episode is defined as a period of acute signs and symptoms due to intervertebral disc syndrome that requires bed rest prescribed and treated by a physician.  The record documents no incapacitation under this definition in the 12-month period prior to the MEB examination.  The Board agreed that no rating could be recommended under this code.  The Board found no other appropriate codes for consideration and no pathway to a disability rating higher than 20%.  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.

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 painful neck 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 20130912, 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 
XXXXXXXXXXXXXXX, AR20150010409 (PD201301287)

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