RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	      CASE:  PD-2014-01427
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20060815

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, OH-58D Helicopter Repair, medically separated for a neck pain condition, rated at 10%.  

CI CONTENTION:  The applicant makes no specific contention in his application.  His 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 - 20060504	VARD -  20061010  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Neck Pain with a History…	5241	10%	Residuals of Cervical Spinal Cord and Cervical Spine Injury, Status Post Discectomy  and Fusion	5241	20%	20060620 	
RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Cervical Spine Condition.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI suffered a debilitating neck injury in October 2003 after landing on his head from a trampoline-like apparatus.  Magnetic resonance imaging (MRI) revealed ligamentous injury with instability at the C5-C6 level, and he required a C5-C6 cervical discectomy and fusion.  A repeat MRI in June 2005 showed post-operative changes and minimal degenerative disc disease.  Despite treatment, the CI’s neck condition could not be adequately rehabilitated to meet the physical requirements of his military specialty and was referred for an MEB.  

Multiple notes by Physical Medicine and Rehabilitation (PM&R) between June and November 2005 recorded ongoing neck pain related to myofascial pain syndrome and intermittent bilateral hand numbness with prolonged typing.

At the NARSUM evaluation on 26 January 2006 (7 months prior to separation) the CI reported the regular occurrence of severe neck pain with exacerbations.  Examination showed posterior neck tenderness.  At the MEB examination (recorded on DD Forma 2807 and 2808) dated 1 February 2006, the CI reported loss of neck motion, and numbness and tingling in arms and hands.  Examination showed cervical spine tenderness and painful motion.

Range-of-motion (ROM) measurements by physical therapy (PT) on 3 February 2006 showed cervical flexion of 25 degrees (normal 45 degrees) and combined ROM of 225 degrees (normal 340 degrees).  There was no change in ROM after repetitive motion.  A PM&R summary on 6 February 2006 reported continued right neck and shoulder pain and “burning and electric-like pain suggestive of a neurogenic etiology.”

At the VA Compensation and Pension (C&P) examination on 20 June 2006 (2 months before separation) the CI reported constant pain at the base of the neck that radiated to the shoulders, arms and hands.  He also claimed a medical recommendation for medically-prescribed bed rest (“incapacitation”) each month for 2 days.  He could not perform activities such as vacuuming, gardening, or pushing a lawn mower, and no longer participated in activities such as basketball, motorcycle riding or softball.  Examination showed a normal gait and spinal contour, and no muscle spasm or tenderness.  Cervical flexion was 20 degrees and combined ROM was 190 degrees.  Painful motion was present.  Upper extremity muscle strength was normal and the examiner stated that “sustained persistent signs of nerve injury are not apparent.”  X-rays were normal except for the known post-surgical changes.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under the 5241 code (spinal fusion), citing limitation of (passive) motion, while the VA assigned a 20% rating using the same code for limitation of forward flexion.  The Board agreed that a 20% rating, but no higher, was justified for limitation of flexion (greater than 15 degrees but not greater than 30 degrees) reported on both exams.  There was no documentation of incapacitating episodes which would provide for a higher rating under that formula.  The Board also deliberated if additional disability was justified for possible upper extremity radiculopathy.  The CI complained of radiating pain to the upper extremities with numbness and tingling.  However, there was no evidence of nerve root irritation or muscle weakness on any exam.  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.  There is no evidence in this case of functional impairment attributable to peripheral neuropathy.  While the CI may have experienced radiating pain, this is subsumed under the general spine rating criteria, which specifically states “with or without symptoms such as pain (whether or not it radiates).”  The Board concluded there was no evidence of functional impairment on the basis of radiculopathy, and that additional disability was therefore not justified on this basis.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 20% for the neck pain condition, coded 5241.

BOARD FINDINGS:  In the matter of the neck pain condition, the Board unanimously recommends a disability rating of 20%, coded 5241 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.  The Board, therefore, recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:

CONDITION	VASRD CODE	RATING	
Neck Pain	5241	20%	
RATING	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140313, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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 XXXXXXXXXXXXXXXXXXXX, AR20160006065 (PD201401427)

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 20%
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: