RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00746
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20021018

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Patriot Launching Station Operator/Maintainer, medically separated for “chronic mechanical neck pain,” with a disability rating of 10%.  

CI CONTENTION:  He was given a higher rating for his condition by the VA.  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 Physical Evaluation Board (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 - 20020820	VARD - 20021127	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Mechanical Neck Pain	5299-5295	10%	DDD, Cervical Spine with insomnia	5290	30%	20020920	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY: 

Chronic Mechanical Neck Pain.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s neck pain began after the CI was hit in the neck by a stretcher, approximately 4 years prior to the NARSUM.  At the two neurology consult examinations in August 2001 (14 months before separation), the CI reported a history of chronic headaches with residual bilateral neck soreness.  Examinations showed mild upper para-cervical tenderness.  Spurling’s test was negative for radicular symptoms.  Radiographs (MRI) of the cervical spine in December 2001 showed disc bulges at C4-5 and C5-6 which caused very minimal deformity at the thecal sac.  No herniations were present.  

Records indicated complaints of upper back pain and left upper extremity sensory symptoms.  A diagnosis of left ulnar neuropathy was considered and electrodiagnostic testing was reported as normal.  A physical therapy (PT) evaluation in February 2002, (8 months before separation) indicated that PT was not effective and was being stopped.  Examination documented full active range-of-motion (ROM) of the cervical spine and upper extremities with slight gross muscle strength of 4+/5 in the neck and upper extremities.  The assessment was a left cervical spine paravertebral muscle trigger point, with a referral to neurology for a Botox injection [to treat the trigger point].  Despite treatment including PT, traction, modified activities, pain medication, and muscle relaxants 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.  

The MEB NARSUM examination on 23 July 2002, (3 months before separation) noted complaints of neck pain preventing the CI from doing his secondary job which got worse with strenuous activities.  The CI denied any pain, numbness, or weakness in his arms, but reported tingling sensation along the ulnar border of his left arm.  The CI’s medications were anti-inflammatories and occasional muscle relaxants.  Physical examination showed that the CI had a non-antalgic gait, mild tenderness to paraspinous muscles, and no overt spasm.  ROM was listed as “full.”  Strength, reflex and sensory testing were normal.  

At the VA Compensation and Pension (C&P) examination in September 2002, performed a month before separation, the CI reported recurrent and chronic pain with stiffness and spasm on and off for 4 years.  Pain was rated 6/10 with tenderness from C4, C5 and C6.  Physical examination showed 1+ stiffness and 2+ spasms with 1+ crepitus.  ROM showed forward flexion of 10 degrees (normal 45); extension of 25 degrees with lateral flexions of 10 degrees each (normal 45); and side bending of 10 degrees each (normal 80).  Testing for radiculopathy (Spurling’s) was negative.  The VA diagnosed and rated left cubital tunnel syndrome (ulnar neuropathy - elbow area nerve condition).  Of note, there were post-separation indicators of employment requiring strenuous physically active and remote physical exams documented full cervical motion.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under an analogous 5295 code (lumbosacral strain), citing characteristic pain on motion.  The VA assigned a 30% rating using the 5290 code (spine, limitation of motion of, cervical) based on the VA C&P examination citing severe loss of motion.  

There is a disparity between examinations with implications for the Board's rating recommendation.  The Board deliberated the probative value of these conflicting evaluations, and carefully reviewed the entire file for corroborating evidence.  The preponderance of the service treatment notes and examinations showed full cervical ROM without spasms.  The single examination documenting spasm and severe loss of motion was the pre-separation VA examination, and records after separation aligned more closely with the service examinations (no significant loss of motion or spasms).  Therefore, based on all evidence and associated conclusions just elaborated, Board consensus was that preponderant probative value should be assigned to the NARSUM examination.  The Board majority concluded that there was therefore insufficient evidence to support a rating higher than the 10% awarded by the PEB (i.e. for more limited motion or under the analogous 5295 criteria for muscle spasm on extreme forward bending or abnormal mobility on forced motion).  

The Board also considered if additional disability rating was justified for peripheral nerve impairment due to radiculopathy.  However, there was no fixed neurologic deficit attributable to the cervical condition and there was no evidence in this case that radiating pain or a neurologic abnormality existed to any degree that could be described as functionally impairing.  

After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board majority concluded that there was insufficient cause to recommend a change in the PEB adjudication for the neck condition.  

BOARD FINDINGS:  In the matter of the neck condition and IAW VASRD §4.71a, the Board majority recommends no change in the PEB adjudication.  The single voter for dissent recommended re-characterization and did not elect to submit a minority opinion.  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 20140210, with attachments
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, AR20160005832 (PD201400746)

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