RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01438
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080223

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated Reservist E7, Infantryman, medically separated for “degenerative disc disease of the cervical spine with headache,” with a disability rating of 10%.

CI CONTENTION: The CI contends his unfitting cervical spine, to include the headaches, and conditions not identified by either the MEB or PEB.  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 based upon a 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 - 20080229	VARD - 20130507	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Degenerative Disc Disease of the Cervical Spine at C3-4 and C6-7 with Headache	5299-5242	10%	Mild Cervical Degenerative Disc Disease	5242	10%	20130110	
			Cervicogenic Headaches	8100	0%		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Cervical Spine Condition with Headache.  According to service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s spinal pain began in late fall of 2006, without direct trauma or injury.  Frequently throughout the STR, the CI’s complaints of headaches were associated with physical running coupled with the presence of spinal pain.  Additionally, a prolonged 2-week period of headaches in October 2006 was concurrent with the CI having an upper respiratory infection with sinus drainage.  Diagnostic imaging performed in February 2007, (12 months prior to separation), revealed mild degenerative changes at C3-4 and a bulging disc at C6-7 with mild impingement of the corresponding nerve root.  Electro-diagnostic studies performed in December 2007, were negative for radiculopathy.  Surgery was not indicated.  Despite conservative treatment to include manipulation and a single epidural steroid injection, 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 “cervical spondylosis with C3-4 and C6-7 DDD and cervicalgia, headache” for PEB adjudication.

At the MEB NARSUM examination (3 months prior to separation) the CI additionally endorsed occasional numbness into the left neck, shoulder, and arm, but denied distal sensory loss.  His physical examination (PE) revealed mild spasm in the upper back muscle (trapezius) without evidence of pain, tenderness, or abnormal radicular signs.  Cervical range of motion (ROM) was normal excepting a 5 degree decrease in extension (normal 45) as well as bilateral lateral flexion (normal 45).  The combined ROM was 325 degrees (normal 340).  The NARSUM also noted that wearing the Kevlar helmet and a ruck sack caused strain and discomfort on the CI’s neck and shoulder muscles which triggered a headache.  There were no prostrating headache attacks noted in the file and no mention of time lost from work due to headaches.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under an analogous 5299-5242 code (degenerative arthritis), citing painful motion.  The VA also assigned a 10% rating using the 5242 code based on the remote VA Compensation and Pension (C&P) examination, citing neck pain.  The Board agreed that a 10% rating, but no higher, was justified for combined ROM (greater than 170 degrees but not greater than 335 degrees) as reported on the NARSUM examination.  Although there was upper back/neck muscle spasm, it was not severe enough to result in abnormal gait or spinal contour, thus the next higher 20% rating was not justified on this basis.  Board members also agreed that the headache component was not a separately unfitting condition, but rather a contributing factor and symptom resulting from the primary neck condition.  

The Board also considered if additional disability rating was justified for peripheral nerve impairment due to a radiculopathy.  Although the CI reported occasional numbness into his left neck and shoulder; the electro-diagnostic studies revealed no evidence of neuropathy or radiculopathy.  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 any nerve involvement, it is subsumed under the general spine rating criteria, which specifically states “with or without symptoms such as pain (whether or not it radiates).”  Therefore, the critical decision is whether or not there was a significant neurologic impairment which would impact military occupation specific activities.  There was no evidence in the case file 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 neck condition with headaches.

BOARD FINDINGS:  In the matter of the neck condition with headache and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  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 20140323, 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 XXXXXXXXXXXXXXXXXXXXXXX AR20160010349 (PD201401438)

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