RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01423
BRANCH OF SERVICE:  Navy 	SEPARATION DATE:  20070307

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E5, Master-at-Arms, medically separated for “cervical strain,” with a disability rating of 10%.

CI CONTENTION:  “I am in pain – all day, every day.  I was unable to continue my military career.  I am no longer a fully functional person.” 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 - 20060926	VARD - 20070321	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Cervical Strain	5237	10%	Degenerative Disc Disease of the Cervical Spine	5242	0%	20061115	
C5-C6 Subligamentous Herniation w/o Neurologic Compromise	Cat II					
Cervical Spondylosis	Cat II					
Migraine Headache	Cat III	Migraine Headaches	8100	0%	20061115	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Cervical Strain.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s neck condition began in 2002, and was aggravated in 2005 after a fall and again in 2006 from a motor vehicle accident.  Radiographic imaging studies in 2005 showed disc protrusion at C5-C6 without impact on nerve roots, which was unchanged on repeat study in 2006.  Electrodiagnostic studies showed no evidence of peripheral or entrapment neuropathy or radiculopathy.  There was no surgical indication and conservative treatment, to include epidural steroid injections, did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “cervical spondylosis, cervical strain and C5-6 subligamentous herniation” for PEB adjudication.  

At the time of an orthopedic clinic appointment on 1 May 2006 (10 months before separation) the CI reported constant 6/10 stabbing, aching pain with numbness and tingling in her bilateral hands, but no weakness.  Physical examination showed a normal gait, tenderness and mild muscle spasm.  Flexion was 35 degrees (45 degrees normal) and combined range of motion (ROM) was 260 degrees (340 degrees normal).  Painful motion was present and upper extremity sensation and muscle strength was normal.  A test for nerve root irritation was negative.

The MEB orthopedic NARSUM examination on 16 August 2006 (7 months prior to separation) noted complaints of continuous discomfort in the cervical spine.  The physical examination showed a normal gait.  Cervical flexion was 45 degrees and combined ROM was 315 degrees.  “Minor” painful motion was present.  There was no weakness or other neurologic abnormalities of the upper extremities.  The MEB physical examination (recorded on DD Form 2808) on 28 August 2006 documented a “full” ROM of the neck with tenderness and painful motion.

At the VA Compensation and Pension (C&P) examination on 15 November 2006 (4 months before separation) the CI reported constant pain at the base of her neck with radiation to her arms, fingertips, shoulders and head.  Exacerbating factors were lifting, running or repetitive bending.  It was difficult to wash her hair because of her neck pain.  Flare-ups occurred once per week and lasted 24-48 hours.  She also noted numbness and tingling in her hands and arms that occurred daily and lasted for a few seconds to 4 hours.  The physical examination showed a normal gait and no spinal deformity.  Tenderness was present, but painful motion and muscle spasm were absent.  Cervical flexion was 45 degrees and combined ROM was 300 degrees.  Upper extremity strength and sensation was normal.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the cervical strain condition 10% under the 5237 code (cervical spine strain).  The VA assigned a 0% rating using the 5242 code (degenerative arthritis of the spine), citing no painful or limited motion, but later increased the rating to 10% based on an examination 15 months after separation.  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) noted on the orthopedic exam 10 months prior to separation, and for combined ROM (greater than 170 degrees but not greater than 335 degrees) reported on the NARSUM and C&P exams.  Tenderness, painful motion and mild spasm reported by the NARSUM were also routes to a 10% rating.  There was no muscle spasm or guarding severe enough to result in abnormal gait or spinal contour reported by any examiner, thus the next higher 20% rating was not justified on this basis.  

The PEB listed the C5-C6 subligamentous herniation (without neurological compromise) and cervical spondylosis conditions as related diagnoses (Category II) contributing to the disability in this case.  The Board agreed that these conditions were related to the underlying diagnosis (cervical strain) and were not conditions which could be separately rated, IAW §4.14 (avoidance of pyramiding).  There was no documentation of intervertebral disc syndrome (IVDS) with incapacitating episodes which would provide for a higher rating under that formula (for IVDS).  The Board also considered if additional disability rating was justified for peripheral nerve impairment due to radiculopathy.  The CI reported radiating pain, numbness and tingling in her upper extremities.  However, although radiographic studies showed disc protrusion, there was no impingement on a nerve root; and electrodiagnostic studies were negative.  All physical examinations were likewise normal, showing no evidence of neurologic compromise.  The presence of functional impairment with a direct impact on fitness is the key determinant in the Board’s decision to recommend any condition for rating as additionally unfitting.  While the CI may have suffered additional pain from the nerve involvement, this is subsumed under the general spine rating criteria, which specifically states “with or without symptoms such as pain (whether or not it radiates).”  There was no evidence in this case that a neurologic abnormality existed to any degree that could be described as functionally impairing.  The Board therefore concluded that additional disability rating was not justified on this basis.  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 cervical strain condition.

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that the migraine headache condition was not unfitting.  At a final neurology visit 4 months prior to separation the CI reported that her “headaches are gone” due to treatment with a prophylactic medication.  The migraine headaches were not included in the limited duty (LIMDU) abbreviated medical evaluation board report and were not judged to fail retention standards by the MEB.  There was no performance-based evidence from the record that migraine headaches significantly interfered with satisfactory duty performance at separation.  After due deliberation, and in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the migraine headaches contended condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the cervical strain condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended migraine headaches condition, the Board unanimously recommends no change from the PEB determination as not unfitting.  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 20131226, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW
               BOARDS 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS
 
Ref:   (a) DoDI 6040.44
       (b) CORB ltr dtd 18 Apr 16

      In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for the reasons provided in their forwarding memorandums, approve the recommendations of the PDBR that the following individual’s records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy’s Physical Evaluation Board:

		- XXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXX, former USN