RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00381
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040604

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an Reserve, 03, AH-64 Attack Helicopter Pilot, medically separated by the Informal Physical Evaluation Board (IPEB) for neck pain, rated at 10%.  

CI CONTENTION:  His condition continues to worsen and should have included other conditions related to his neck condition.  His condition negatively impacts his daily activities.  The applicant
s complete submission is at Exhibit A.    

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  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 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 Veterans Affairs Schedule for Rating Disabilities (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 PEB - 20040223	VARD - 20050224	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Neck Pain, Due to Cervical Degenerative Disc Dis., without Neurologic Abnormality	5299-5237	10%	Compression Fracture C5 C6 with Residual Cervical Spine Pain and Limitation of Motion	5235	20%	20051115	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDTIONS:  30%	

ANALYSIS SUMMARY: 

Cervical Degenerative Disc Disease.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s neck condition began while deployed in July 2002 after tripping and falling, striking his head on a fire extinguisher injuring his neck.  Radiographic studies showed a mild compression fracture and degenerative disc disease.  His neck pain worsened on a subsequent deployment to and he was grounded from flying duties and returned to his home base in August 2003.  Imaging with magnetic resonance scanning in November 2003 revealed degenerative disc disease.  Consultation with orthopedic surgery concluded there was no surgical indication.  Despite treatment, the CI’s neck condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and was referred for an MEB.  

At the time of the physical therapy clinic appointment on 12 January 2004, 5 months prior to separation, the CI reported 18 months of neck pain as well as a recent episode (20 December 2003) of numbness and tingling in the left upper extremity.  On examination cervical spine ROM was limited as recorded in the chart and associated with painful motion.  Strength, reflexes and sensation were normal.  At the MEB examination (recorded on DD Forms 2807 and 2808) dated January 2004, 5 months prior to separation, the CI reported two recent events of numbness and tingling in his left upper extremity as well as a sharp pain radiating into his right shoulder blade area. Physical exam showed decreased cervical range of motion, but did not specify the degree of limitation.  The MEB NARSUM dictated 5 February 2004 (4 months prior to separation) noted that his pain had decreased with medication use and that he had not experienced any cervical radicular pains to include numbness tingling, or weakness of the arms.  The neck pain was noted to have been aggravated by the wear of heavy military headgear.  Physical exam, conducted on 20 January 2004, showed painful motion with normal strength.  The examiner noted there was decreased ROM noted on an orthopedics examination with pain on extension (the orthopedic examination was not available in the record).  At the VA Compensation and Pension (C&P) examination on 15 November 2004, performed 5 months after separation, the CI reported that his neck pain was worsened when he bended or turned his neck to the right or left and held the neck in one position for a long time.  He reported that he had two episodes of numbness of the hands which were very brief and self-limited.  He reported he was unable to do the same exercise routine as before and was not able to wrestle with his brothers.  He also reported that he had flare-ups that usually lasted a few hours to a whole day or two and that they were precipitated by sitting in the same position for long periods of time such as working on a computer, however there were no incapacitating episodes requiring bed rest prescribed by a physician.  On physical examination the CI’s posture was normal but he was observed to be stretching the neck during the examination.  Physical exam showed no neurologic deficits and cervical spine range of motion after repetition was limited as recorded in the chart and associated with painful motion. The examiner noted that, “Repetitive movements of the neck did not worsen the patient's pain or change in the range of motion. The patient's neck exam was not limited by weakness, fatigability.”  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under an analogous 5237 code (Cervical Strain), citing painful limitation of motion with localized tenderness, and no neurologic abnormality.  The VA assigned a 20% rating using the 5235 code (Vertebral Fracture or Dislocation) based on 10% for limitation of forward flexion, and an additional 10% for functional loss due to painful motion.  The Board agreed that a 10% rating, but no higher, was justified for limitation of flexion (greater than 30 degrees but not greater than 40 degrees and/or combined ROM greater than 170 degrees but not greater than 335 degrees as reported on the MEB physical therapy and VA exams. There was no muscle spasm or guarding severe enough to result in abnormal gait or spinal contour, thus the next higher 20% rating was not justified on this basis.  The Board noted the VA increased the rating to 20% based on additional functional loss due to pain.  The Board considered if there was additional functional loss due to pain and weakness with use beyond that reflected in the measured limitation of his cervical spine motion after repetitive motion.  The pain was aggravated by movement or holding the same position and the CI could not engage in his prior exercise regimen or wrestle.  The VA C&P examiner noted that repetitive movement did not worsen his pain, change the range of motion or result in limitation due to weakness or fatigability.  Considering VASRD §4.40, §4.45, and §4.59, the Board agreed that there was some additional functional limitation due to painful motion during flare‐ups; however, the evidence did not show additional functional limitations which approximated the criteria for the next higher rating.  There was no documentation of incapacitating episodes which would provide for a higher rating under that formula or evidence of ratable peripheral nerve impairment which would provide for additional rating.  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:  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.  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 20131210, 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 XXXXXXXXXXXXXXXXXX, AR20160005439 (PD201400381)

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:

Enclosure

CF: 
(  ) DoD PDBR
(  ) DVA