RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2014-00021
BRANCH OF SERVICE:  Army	BOARD DATE:  20140805
Separation Date:  20060709

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty PFC/E-3 (11B/Infantryman) medically separated for chronic neck pain.  The 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 “chronic neck pain” condition 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 pain after traumatic injury on airborne operation in February 2005” as unfitting, rated 10%, with application of AR 635-40.  The CI made no appeals and was medically separated.

CI CONTENTION:  “Worsening condition of thoracic spine and cervical spine strain.  Worsening condition of 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 those conditions identified but not determined to be unfitting by the PEB when specifically requested by the CI.  The rating for the unfitting chronic neck pain condition is addressed below. No additional conditions, including left knee pain, 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. IAW DoDI 6040.44, the Board’s authority is limited to making recommendations on correcting disability determinations.  The Board’s role is thus confined to the review of medical records and all evidence at hand to assess the fairness of PEB rating determinations, compared to VASRD standards, based on ratable severity at the time of separation.  The Board acknowledges the CI’s information regarding the significant impairment with which his service-connected condition continues to burden him; but, must emphasize that the military Disability Evaluation System has neither the role nor the authority to compensate service members for anticipated future severity or potential complications of conditions resulting in medical separation.  That role and authority is granted by Congress to the Department of Veterans' Affairs, operating under a different set of laws.  

RATING COMPARISON:

Service IPEB – Dated 20060503	VA - (2 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Neck Pain	5299-5237	10%	Cervical Spine Strain-claimed as neck condition	5237	10%	20060921	
Other x 0 (Not in Scope)	Other x 2 (Not in Scope)	
Combined:  10%	Combined:  30%	
Derived from VA Rating Decision (VARD) dated 20061130 (most proximate to date of separation [DOS])

ANALYSIS SUMMARY: The Board makes note that some of the CI’s contended conditions are derived from VA evaluations performed well after separation and that his current VA ratings are higher than those reflected in the above rating chart.  Although some of these conditions and ratings were assigned an effective date to the time of separation, the earliest VA rating examination underpinning them was performed 2 months after separation.  The Board’s operative instruction, DoDI 6040.44, specifies a 12-month interval for special consideration to VA findings.  This does not mean that the later VA evidence was disregarded, but the Board’s recommendations are directed to the severity and fitness implications of conditions at the time of separation.  In this circumstance, therefore, the evidence from the service record is assigned significantly more probative value as a basis for the Board’s recommendations.

Chronic Neck Pain Condition.  The CI sustained an injury to his neck in February 2005 during an airborne operation when he had a hard landing onto the left side of his body.  He developed more pain in his neck and back after he got back up and carried his combat load.  The CI was able to complete the operation, but subsequently reported to sick call for evaluation.  The primary care provider noted continued neck pain for two weeks after the jump and radicular symptoms in a C7-8 distribution, and referred the CI to physical therapy (PT) for evaluation and treatment.  A cervical spine X-ray was normal.  A cervical spine magnetic resonance imaging (MRI) demonstrated joint osteophytes from C4-5 to C5-7, minimal disc desiccation from C4-5 to C6-7, and a very small lateral disc protrusion present at C6-7; however there was no significant disc herniation or cord compression.  The CI was evaluated by PT who noted pain that averaged 5-6/10 in the neck with minimal relief from a variety of therapies.  The examiner diagnosed myalgia and myositis with diffuse cervical, thoracic, and high lumbar myofascial pain.  The CI was also referred to a chiropractor who documented constant dull neck pain and stiffness with an occasional sharp increase with activity.  The CI followed with the chiropractor for six treatments with a poor response.  The physical medicine examiner documented neck pain, numbness in the last two digits and the ulnar aspect of the forearm, with pain that averaged 5-6/10.  The CI was referred back to PT for more specific therapy.  The CI was given a permanent U3 Profile for neck pain cervical spondylosis (neck spinal disc herniation and arthritis) and the commander’s statement noted that the CI continued to experience muscle spasms, lack of sleep, mild to severe pain, and frequent headaches which interfered with his MOS duty performance.  The MEB narrative summary (NARSUM) exam, approximately 3.5 months prior to separation, documented that the CI continued to have significant limitations with running, road marching with more than 15 pounds, and an inability to wear his protective equipment to perform airborne operations or to perform any of the primary events for fitness testing.  He further documented that the CI had a poor response despite multiple treatment modalities by PT, a chiropractor, and physical medicine.  The VA Compensation and Pension (C&P) exam performed approximately 2.5 months after separation documented that the CI had constant neck stiffness with a pain level rated at 6/10 and worsened with physical activity.  He further noted that the CI could function without medication; however, he had pain with any movement of the neck.  

The Board directs attention to its rating recommendation based on the above evidence.  The PEB coded the chronic neck pain condition as 5299 analogous to 5237 (lumbosacral or cervical strain) and rated at 10%.  The VA also coded the cervical spine strain (claimed as neck condition) condition as 5237 and rated at 10%.  The General Rating Formula for Diseases and Injuries of the Spine considers the CI’s pain symptoms “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.”  Both the PEB and the VA exams met the 10% rating criteria.  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 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.  As discussed above, PEB reliance on the AR 635-40 for rating chronic neck pain was operant in this case and the condition was adjudicated by the Board independently of that regulation.  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 re-characterization of the CI's disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20131223, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

			
XXXXXXXXXXXXXXX
President
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, AR20150003734 (PD201400021)

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