RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00722
BRANCH OF SERVICE:  Army	BOARD DATE:  20150416
Separation Date:  20061130

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-6 (Bradley Fighting Vehicle Operator) medically separated for chronic neck pain.  The conditions could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty.  He was issued a permanent U3/L2 profile and referred for a Medical Evaluation Board (MEB).  The neck pain condition, characterized as “chronic neck pain with degenerative disc disease and a herniated nucleus pulposus at C5-C6 with upper extremity radiculopathy,” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  Five other conditions (anxiety, right knee pain, intermittent headaches, thoracic degenerative disk disease and impaired glucose reading) were submitted by the MEB as diagnoses that do not cause Soldier to fall below retention standards.  The Informal PEB adjudicated “chronic neck pain,” as unfitting, rated 0%, with likely application of AR 635-40.  The CI did not agree and requested a Formal Hearing but later withdrew his request and he was medically separated.

CI CONTENTION:  “The CI elaborated no specific contention 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 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 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:

IPEB – Dated 20061011	VA* - (~5 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Neck Pain	5243	0%	Cervical Spondylosis	5024	10%	20070402	
Other x5 (Not In Scope)	Other x 8	
RATING:  0%	RATING:  70%	
*Derived from VA Rating Decision (VARD) dated 20070718 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:  IAW DoDI 6040.44, the Board’s authority is limited to making recommendations on correcting disability determinations.  The Board reviews medical records and other available evidence to assess the fairness of PEB rating determinations, using the VASRD standards, based on ratable severity at the time of separation.

Chronic Neck Pain Condition.  The CI jumped and fell off of an M-88 vehicle in Iraq, and landed on his back when they came under mortar attack in January 2005.  He began noticing some muscle spasms in his back in March 2006 and went to an Aid Station and was given medications.  Three days later, the stiffness resolved, however he noted muscle spasms in his upper back.  He had an onset of neck pain that radiated to his right arm in April 2006.  A cervical spine X-ray showed narrowing at the right neuroforamen at C4-5 level.  A cervical spine magnetic resonance imaging showed slight bulging at C4-5 and evidence of right central herniated disc at C5-6.  The Orthopedist documented neck and right arm pain with mild diffuse arm weakness.  There were physical exam findings of slightly decreased grip strength on the right compared to the left with normal sensation and reflexes.  The examiner diagnosed C5-6 degenerative disc disease with herniated nucleus pulposus and right upper extremity radiculopathy.  The CI received his first epidural steroid injection on 13 June 2006.  The pain specialist noted that although CI’s symptoms had improved they were not completely resolved.  The second epidural steroid injection was administered at this pain clinic visit.  The primary care provider briefly noted on going weakness and decreased sensation in the muscles and diagnosed cervical radiculopathy.  The MEB narrative summary exam 2 months prior to separation documented that the CI is right hand dominant and had an aching pain in the posterior aspect of his neck and into the right side of his neck with radiation down into the right arm and forearm.  The CI had associated numbness and tingling into his right thumb and index finger.  He estimated that the neck pain was 40% of the time with an average pain level of 4/10.  His condition was aggravated by running due to the jarring creating pain, lifting and prolonged sitting, sit-ups and pushups.  The VA Compensation and Pension (C&P) exam 4 months after separation documented occasional sharp, throbbing pain that radiated from the neck into his right upper extremity.  There were no periods of incapacitation.  The VA C&P physical exam findings are summarized in the chart below.  The VA examiner noted radicular pain that radiated down the right upper extremity.  A cervical spine X-ray showed mild arthritic changes.  The electromyogram performed on done 4 April 2007 demonstrated a mild to moderate degree of entrapment neuropathy involving both median nerves compatible with a diagnosis of mild to moderate degree of bilateral carpal tunnel syndrome.

There were two range-of-motion (ROM) evaluations in evidence, with documentation of additional ratable criteria, which the Board weighed in arriving at its rating recommendation; as summarized in the chart below.

Cervical ROM (Degrees)	MEB ~2.5 Mo. Pre-Sep	VA C&P ~4 Mo. Post-Sep	
Flex (45 Normal)	45	45	
Combined (340)	330	290	
Right Hand Dominant	Pos. painful motion & mild tenderness over right cervical trapezius; Normal strength, sensation & reflexes	Pos. painful motion & tenderness paracervical muscles; midline cervical pain over lower cervical segments	
§4.71a Rating	10% (PEB 0%)	10% (VA 10%)	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB coded the chronic neck pain as 5243 (intervertebral disc syndrome) and rated at 10% with application of AR 635-40.  The VA coded the cervical spondylosis as 5024 (tenosynovitis) and also rated it 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.  The MEB examiner documented pain with all ROM’s, mild tenderness over the right upper trapezius and a combined ROM of 330.  The CI met the 10% rating criteria of “combined range of motion of the cervical spine greater than 170 degrees but not greater than 335 degrees” and “localized tenderness not resulting in abnormal gait or abnormal spinal contour.”  Board precedent is that a functional impairment tied to fitness is required to support a recommendation for addition of a peripheral nerve rating at separation.  The pain component of a radiculopathy is subsumed under the general spine rating as specified in §4.71a.  The sensory component in this case has no functional implications.  The motor impairment was either intermittent and cannot be linked to significant physical impairment.  Since no evidence of functional impairment exists in this case, the Board cannot support a recommendation for additional rating based on peripheral nerve impairment.  Additionally, there were no episodes of incapacitation to allow for a rating based on such episodes under code 5243.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the chronic neck pain condition without the addition of a peripheral neuropathy 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 AR 635-40 for rating the chronic neck pain condition was operant in this case and the condition was adjudicated independently of that policy by the Board.  In the matter of the chronic neck pain condition, the Board unanimously recommends a disability rating of 10%, coded 5243 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION:  The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation:

UNFITTING CONDITION	VASRD CODE	RATING	
Chronic Neck Pain	5243	10%	
COMBINED	10%	

The following documentary evidence was considered:
Exhibit A.  DD Form 294, dated 20140205, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20150013267 (PD-2014-00722)

Dear XXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document       (DD Form 214, Certificate of Release or Discharge from Active Duty) or the amount of severance pay.  However, it will require a new separation order.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction. 

	A copy of this decision has also been provided to the Department of Veterans Affairs.

Sincerely,

Enclosure