RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01162
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070321

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Satellite Communications Systems Operator/Maintainer, medically separated for “chronic neck pain status post C2 and C5 fractures,” with a disability rating of 0%.

CI CONTENTION:  The CI’s condition continues to worsen and negatively impact daily activities.  The CI’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 - 20070125	VARD - 20080314	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Neck Pain Status Post C2 and C5 Fractures	5235	0%	Cervical Fractures, well healed, with Disc Space Narrowing	5235	10%	20071101	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Chronic Neck Pain Status Post C2 and C5 Fractures.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI was a restrained passenger in a car accident in late October 2005.  He sustained fractures of C2 and C5 vertebra.  The civilian neurosurgeon opined that none were “terribly significant, but which compounded together pose some risk to spinal alignment…”These were treated with 12 weeks in a “Halo” device followed by an additional month in a soft collar.  He was then on 60 days convalescent leave.  Surgery was not required.  He was cleared to return to full duty, but reported increased pain with the wear of a combat helmet and Kevlar gear sufficient to preclude their use.  Despite treatment, the cervical spine condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for MEB.  The MEB forwarded “chronic neck pain status post C2 and C5 fractures.”  The MEB examination (recorded on DD Forms 2807 and 2808) dated November 2006, 4 months prior to separation, was unremarkable.  The MEB narrative summary (NARSUM) noted that the main difficulty was being unable to tolerate a Kevlar helmet or a fully loaded rucksack.  The range of motion (ROM) is charted below.  No comment was made on pain with motion, but neither tenderness nor spasm was present.  X-rays were consistent with complete healing.  He did show some disc degeneration at C2-3 on MRI.  At the VA Compensation and Pension (C&P) examination in November 2007, performed 7 months after separation, the CI reported occasional “stiffness” with no radicular pain, no numbness, no weakness and no headaches.  The CI additionally reported the neck condition was “getting better with time.”  The physical examination showed “slight limitation of flexion”, normal vertebral bodies, intervertebral disc spaces and articular structures.  Cervical X-rays showed no residuals of the C2 and C5 fractures.  On ROM testing, he had stiffness and soreness.  The values are charted below.  The ROM examinations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.  

Cervical ROM
(Degrees)	MEB 2808~4 Mos. Pre-Sep 	MEB ~4 Mos. Pre-Sep	VA ~7 Mos. Post-Sep	
Flexion (45 Normal)	45	35	45	
Combined (340)	295	245	310	
Comments	Normal Neurological Examination	Impairs duty	No change with repetition	
§4.71a Rating	10%	10%	10%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 0% rating under the 5235 code (vertebral fracture or dislocation), citing motion is limited by pain.  The VA assigned a 10% rating using the same 5235 code (Vertebral fracture or dislocation) based on the VA C&P examination 7 months after separation, citing weekly neck “stiffness and soreness.”  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 the limited combined ROM (greater than 170 degrees but not greater than 335 degrees) recorded on the MEB examination 4 months before separation.  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, coded 5235.  The Board noted that the VA rated the CI for scars.  It found no evidence that these impaired duty.  In addition, the VA examiner documented that there was no functional limitation.  The evidence does not support the addition of the scars as additional unfitting conditions and no additional rating is recommended.  

BOARD FINDINGS:  In the matter of the chronic neck pain condition, the Board unanimously recommends a disability rating of 10%, coded 5235 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.  The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Neck Pain	5235	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140128, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB

MEMORANDUM FOR Commander

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation
for XXXXXXXXXXXXXXXXXX, AR2016001 0632 (PD201401162)

1. 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, accept the Board's recommendation to modify the individual's disability rating to 10% without re-characterization of the individual's separation. This decision is final.

2. I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum.

3. I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

BY ORDER OF THE SECRETARY OF THE ARMY:

CF:
( ) DoD PDBR
( ) DVA