RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXX	CASE:  PD-2013-01826
BRANCH OF SERVICE:  Army	BOARD DATE:  20140423
SEPARATION DATE:  20051206

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated National Guard CWO2/WO2 (154CB/CH-47D Helicopter Pilot) medically separated for chronic cervical spine pain.  As the CI was not considered a surgical candidate, he was treated conservatively until such time it became apparent he 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 U3/L2 profile and referred for a Medical Evaluation Board (MEB).  The neck pain condition, characterized as “cervical DJD, DDD and myofascial pain syndrome causing neck and right shoulder pain” was forwarded to the Physical Evaluation Board (PEB) as medically unacceptable IAW AR 40-501.  The MEB also identified and forwarded five other conditions as medically acceptable.  The PEB adjudicated “chronic cervical spine pain” as unfitting, rated 10%, with likely application of the VA Schedule for Rating Disabilities (VASRD).  The five medically acceptable conditions referred by the MEB were found not unfitting by the PEB.  The CI made no appeals and was medically separated.

CI’s CONTENTION:  The CI elaborates no contentions 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 cervical spine condition is addressed below.  No other conditions are within the DoDI 6040.44 defined purview of the Board.  Any conditions outside the Board’s defined scope of review may be eligible for consideration by the Board for Correction of Military Records.

RATING COMPARISON:

Service IPEB – Dated 20051027	VA – (~2 mo. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Cervical Spine Pain	5237	10%	DJD; DDD of Cervical Spine	5242-5243	10%	20060125	
No Additional MEB/PEB Entries	Other x 7	20060119	
Combined:  10%	Combined:  30%	
Derived from VA Rating Decision (VARD) dated 20060510 (most proximate to date of separation [DOS])  
* VARD 20100513 increased DC 5242-5243 to 20% from 20100324.  VARD 20110909 awarded DC 5242-5243 at 20% disability level from an earlier date of entitlement:  20070306.  

ANALYSIS SUMMARY: 

Chronic Neck Pain.  In September 2002, this CI was involved in a helicopter mishap in which the aircraft shook violently on the ground.  After that incident, he complained of neck pain. Magnetic resonance imaging of the cervical spine showed degenerative disc disease at multiple levels.  He was treated with multimodality physical therapy (PT) including exercises, heat, massage and electro-stimulation.  However, the symptoms persisted and an MEB was initiated.  The MEB clinical evaluation was in September 2005.  On physical examination (PE), he was alert and in no apparent distress.  The neck was nontender to palpation.  Neurological exam of the arms and hands was normal.  Cervical range-of-motion (ROM) was measured by PT and is summarized in the chart below.

The CI was medically separated from service on 6 December 2005.  Seven weeks later on 25 January 2006, he had a VA Compensation and Pension (C&P) exam.  PE of the neck revealed some tenderness in the low cervical region.  Neurological testing of the upper extremities did not show any significant deficits.  The cervical ROM evaluations which the Board weighed in arriving at its rating recommendation are summarized in the chart below.

Cervical ROM
(Degrees)	PMR ~ 19 wks. Pre-Sep
(20050726)	MEB ~ 10 wks. Pre-Sep
(20050926)	VA C&P ~ 7 wks. Post-Sep
(20060125)	
Flex (45 Normal)	45	30	45	
Extension (45)	45	0	35	
R Lat Flexion (45)	not measured	30	25	
L Lat Flexion (45)	not measured	45	35	
R Rotation (80)	80	65	50	
L Rotation (80)	80	60	70	
Combined (340)	(n/a)	230	260	

The Board carefully examined all available evidence and directs attention to its rating recommendation.  The Army PEB and the VA chose different coding options for the neck condition, but both assigned a disability rating of 10%.  The Board noted the disparity in the examinations shown above.  The Board determined that the January 2006 C&P exam had greater probative value.  It was conducted in a thorough manner and was closer in temporal proximity to the date of separation.  At that exam, the CI had 44 degrees of cervical flexion and 260 degrees of combined cervical ROM.  IAW the VASRD §4.71a, a disability rating of 10% is warranted when combined cervical ROM is greater than 170 degrees, but not greater than 335 degrees.  After reviewing the evidence, all Board members agreed that a rating of 10% was appropriate 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 neck condition.  The other VASRD codes that were considered did not result in a higher rating, since the treatment record did not show sufficient evidence of a disabling spine condition which would justify a rating higher than 10%.

The Board also considered the matter of peripheral neuropathy.  After reviewing all the information in the record, there was insufficient evidence of a clinically significant neuropathy that interfered with performance of military duties.  The CI clearly had radicular symptoms.  However, there was no performance-based evidence that the radicular condition impacted his military duties.  Therefore, the Board concluded that there was no unfitting radiculopathy present at the time of separation.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board found insufficient cause to recommend a change in the PEB adjudication for the chronic neck pain 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 chronic neck 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 recharacterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20131024, 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, AR20150001030 (PD201301826)

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