RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01648
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20080410

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5 (Wheeled Vehicle Mechanic) medically separated for a cervical condition that could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS) or satisfy physical fitness standards. The remaining conditions were determined to be not unfitting.   The CI made no appeals and was medically separated. 

CI CONTENTION:  The CI made 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, Enclosure 3, paragraph 5.e. (2).  It is limited to those conditions determined by the 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/Naval 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:  

Admin Corr. IPEB - Dated 20080409	VA* - (~4 Mos. Pre-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Neck Pain … No Neuro Deficit	5237	10%	Cervical Strain	5237	10%	20071205	
Other MEB/PEB Conditions x 5 (Not In Scope)	Other x 15 (equals SC, NSC & deferred)**	
RATING:  10%	RATING:  80%	
*   Derived from VA Rating Decision (VARD) dated 20081024 (most proximate to date of separation [DOS]).  
** Included “chronic neck pain with history of cervical disc herniation C6-C7” listed for vocational rehab purposes.

ANALYSIS SUMMARY:    

Cervical Condition.  The service treatment record (STR) corroborated the history in the narrative summary (NARSUM) of an atraumatic onset of neck (and upper back/trapezial) pain in 2005.  The pain persisted, with occasional left upper extremity symptoms (pain into shoulder and arm, mild sensory, no subjective weakness).  Early magnetic resonance imaging (MRI) was equivocal for disc protrusion at C6/7, but a repeat MRI in June 2007 was normal.  There were multiple normal neurological examinations recorded in the STR, with none to the contrary; and, the neurosurgery consultant opined that there were no surgical indications.  The neurosurgeon addressed “upper thoracic back pain and neck pain” (with similar characterization by other examiners), corroborating the PEB’s opinion regarding the nature of the back pain component.  There were STR entries which recorded grossly normal range-of-motion (ROM) observations, with none indicating significant ROM limitations.  Formal ROM measurements for the MEB by physical therapy (PT) were performed in June 2007 (8 months pre-separation, 2 weeks after the NARSUM) and recorded flexion to 40 degrees (normal 45) and combined ROM of 175 degrees (normal 340).  There were two preceding PT entries with measured ROM (5 weeks and 3 weeks prior to the MEB measurements) which recorded flexion to 40 and 45 degrees respectively, and combined ROM of 265 and 225 degrees.  Various STR entries documented a normal spinal contour, although one recorded “decreased lordosis;” and, there was no STR documentation of incapacitating episodes.

The NARSUM was conducted 5 June 2007 (10 months pre-separation [administrative delay pending NDAA decision as above]) and documented persistent pain rated 4-5/10, with exacerbations to 8/10 by “wearing military gear,” heavy carrying, and mounting/dismounting trucks.  The NARSUM did not provide a concurrent physical examination, but recorded recent findings of cervical and upper trapezial tenderness, ROM “limited by pain,” with normal strength (including grip) and sensory findings.  The NARSUM attached the subsequent PT ROM measurements for the MEB (as above).

A VA Compensation and Pension (C&P) examination was conducted 5 December 2007 (4 months pre-separation) and documented constant neck pain “extending into the left arm” rated 6/10 with exacerbations to 8/10 by “prolonged standing, and sitting or driving.”  The VA physical examination recorded the absence of tenderness (no comment regarding spinal contour) and normal strength and neurological findings.  The VA measured ROM was flexion to 45 degrees and combined 310 degrees.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB’s 10% rating under code 5237 (cervical strain), although possibly incorporating guidance from AR 635-40, was consistent with VASRD §4.71a criteria for the Service ROM evidence and ratable findings.  The VA’s 10% rating under the same code was consistent with the C&P findings and measured ROM.  There was insufficient evidence of abnormal spinal contour to achieve a higher rating, no evidence of additionally ratable peripheral nerve impairment, and no documentation of incapacitating episodes would provide for a higher rating under that formula.  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 of the cervical spine condition.

BOARD FINDINGS:  IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB will not be considered by the Board to the extent they were inconsistent with the VASRD in effect at the time of the adjudication.  As discussed above, possible PEB reliance on AR 635-40 for rating was operant in this case and it was adjudicated independently of that regulation by the Board.  In the matter of the cervical spine condition 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.

RECOMMENDATION:  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 20140418, w/atchs
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, AR20160003260 (PD201401648)

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