RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXXXX	      CASE: PD-2014-01725 
BRANCH OF SERVICE:  Army                                                                  SEPARATION DATE:  20080707	

Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated Army Reserve 05, Medical Services Officer, medically separated for a “cervical strain” with a disability rating of 10%.

CI CONTENTION:  The CI elaborated no specific contention in her application.  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 - 20080507	VARD - 20100223 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Cervical Strain	5237	10%	Cervical Spine Spondylosis	5237	10%	20091022	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS: 60%	

ANALYSIS SUMMARY:  

Neck Condition.  Absent direct trauma, the CI developed neck pain and paresthesia into her right arm and hand while exercising in early 2007.  X-rays revealed degenerative disc disease (DDD) of the lower cervical spine.  Her orthopedic diagnosis was listed as cervicalgia (neck pain).  Neurosurgical consultation revealed that the reported tingling in her right upper extremity was “very infrequent” and that her hand dexterity and grip strength was “excellent.”  Surgery was not recommended and she continued treatment with manipulations and physical therapy.  Despite such treatment, her neck pain continued and she was referred to a Medical Evaluation Board (MEB).  
At the MEB narrative summary (NARSUM) examination on 7 April 2008 (3 months prior to separation), the CI endorsed a daily low-grade neck and upper back pain associated with numbness and tingling in her medial forearms and hands.  Symptom aggravators included heavy lifting, general household chores, performing sit-ups and other exercises that stress the neck.  She actively performs core strengthening exercise techniques.  The examiner noted “When adhering to her treatment protocols, [the CI] is quite functional and able to perform both her detective and [military] administrative duties”.  Her physical examination (PE) revealed cervical muscle spasms and neck range of motion (ROM) was listed as “severely limited by pain.”  Neurosensory evaluation of the upper extremities was normal.  Her MEB diagnosis was listed as “non-radicular pain involving the cervical spine, secondary to DDD, failing to respond to adequate conservative treatment and necessitating significant limitation in physical activity.”  At the VA Compensation and Pension (C&P) examination on 22 October 2009 (15 months after separation), the CI reported moderate neck pain with numbness and tingling into the medial aspect of both arms and hands occurring 3-4 days per week.  The PE revealed tenderness about the cervical musculature without spasms.  Strength and sensation was normal.  Cervical ROM was decreased and painful.  Her functional impairment was listed as “slight plus”.  The goniometric ROM evaluations 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 ~3 Mo. Pre-Sep
	VA C&P ~15 Mo. Post-Sep
	
Flex (45 Normal)	45 (59)	40	
Extension (45)	45 (60)	35	
R Lat Flexion (45)	35	30	
L Lat Flexion (45)	25	20	
R Rotation (80)	65	50	
L Rotation (80)	70	45	
Combined (340)	285	220	
Comment	painful motion 	Tenderness, painful motion	
§4.71a Rating	10%	10%	

The Board directed its attention to its rating recommendation based on the above evidence.  Both the PEB and VA rated the cervical spine condition under VASRD code 5237 at 10%.  Due to the remoteness of the VA examination, all Board members agreed that exclusive examination probative value (PV) be given to the MEB at 3 months prior to separation.  Absent compensable ROM and or periods of incapacitation, the presence of painful motion is supported under the application of §4.59.  Considering the totality of the evidence and mindful of VASRD §4.3 (reasonable doubt), members agreed that a disability rating of 10% for the neck condition was appropriately recommended in this case.  

BOARD FINDINGS:  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.  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 20140421, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record
SAMR-RB

28 JUL 2016

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, AR20160007313 (PD201401725)

I have reviewed the enclosed Department of Defense Physical Disability Board of
Review (000 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