RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01762
BRANCH OF SERVICE:  ARMY	BOARD DATE:  20140827
SEPARATION DATE:  20040920

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (52C/Utilities Equipment Repairer) medically separated for a chronic neck condition.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards.  He was issued a permanent U3 profile and referred for a Medical Evaluation Board (MEB).  The chronic neck condition, characterized as “neck pain” by the MEB was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated “chronic subjective neck pain” as unfitting, rated 10% with likely application of the US Army Physical Disability Agency pain policy.  The CI made no appeals and was medically separated.

CI CONTENTION:  “Please consider all conditions.”

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 those conditions identified but not determined to be unfitting by the PEB when specifically requested by the CI.  The rating for the unfitting chronic neck condition is addressed below; and, no additional conditions are within the DoDI 6040.44 defined purview of the Board.  Any conditions or contention not requested in this application, or otherwise outside the Board’s defined scope of review, remain eligible for future consideration by the Board for Correction of Military Records.

RATING COMPARISON:

Service IPEB – Dated 20040819	VA - based on Service Treatment Records (STR)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Subjective Neck Pain	5299-5237	10%	Degenerative Disc Disease, Cervical Spine	5299-5243	10%	      STR	
Other x 0 (Not in Scope)	Other x 8 (Not in Scope)	STR	
Combined:  10%	Combined:  10%	
Derived from VA Rating Decision (VARD) dated 20041027 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Chronic Neck Condition.  The narrative summary (NARSUM) notes that the CI injured his neck in a motor vehicle accident in 1999.  He was diagnosed with a neck sprain and mild concussion and treated with medications.  Notes in the service treatment record indicated that 2 years later, while deployed, he reported his neck began to hurt again for the previous 3 days, with pain radiating down his right side.  An incomplete note in the record indicates he was evaluated by neurosurgery on 9 April 2002 without abnormal findings on examination.  Physical medicine evaluation on 13 August 2002 noted the CI had neck pain that radiated to the lower back, aggravated by wearing Kevlar or a helmet.  On exam painful neck flexion with tenderness to palpation of the lower cervical vertebrae was present with normal strength, sensation and reflexes and negative testing for cervical nerve compression.  The diagnosis was cervical strain and he was given a local injection and referred to physical therapy.  A cervical magnetic resonance imaging (MRI) was ordered in March 2002 while the CI was still deployed and according to the NARSUM it noted cervical disc abnormalities, read by a neurosurgeon as a mild bulging disc at C7, and no surgery was recommended.  In August 2003 the CI was placed on quarters for 48 hours for neck pain and numbness on the right side and was referred to orthopedics for neck pain for 4 years.  The CI was medically evacuated in early September 2003 for chronic progressive degenerative disc disease of the cervical spine with radiculopathy.  At the orthopedic evaluation on 10 September 2003 the CI reported neck pain and right upper extremity (UE) paresthesia and weakness.  The examination noted full range-of-motion (ROM) of the cervical spine with no other abnormality and another MRI was ordered.  At orthopedic follow-up the MRI October 2003 was reported as normal, without evidence of a disc herniation or cervical deformity and electromyography/nerve conduction studies (EMG-NCV) December 2003 were normal.  The CI was diagnosed with degenerative cervical spine disease (spondylosis) and a MEB was recommended. At a primary care visit to initiate the MEB the CI was noted to have full ROM of the neck.

At the MEB examination on 4 May 2004, approximately 5 months prior to separation, the CI reported neck pain.  The MEB physical exam noted full ROM of the spine with normal gait and normal strength, sensation, and reflexes throughout.  Physical therapy ROM of the cervical spine for the MEB performed on 27 July 2004, approximately 2 months prior to separation, noted forward flexion of 30 degrees (normal 45 degrees) with a combined ROM of 160 degrees (normal 340 degrees) , with muscular tightness and guarding due to painful motion.

The original VARD was based upon service medical records with rating of the neck pain condition as noted below.  A VA visit note in the record approximately a year post-separation indicated the CI sought a letter regarding his neck condition in order to re-enlist in the military.  The provider noted that the CI reported that his neck pain had improved with rest and physical training and he had no neck pain in the past year.  The examination noted full ROM without tenderness or painful motion (159) and cervical spine X-rays were normal.

The Board directs attention to its rating recommendation based on the above evidence.  The PEB rated the neck pain condition 10%, code 5299-5237 (analogous to cervical strain).  The VA rated cervical spine degenerative disc disease 10%, coded 5299-5243 (analogous to intervertebral disc syndrome).  The Board agreed that according to VA spine rating guidelines the physical therapy (PT) ROM evidence supports the 20% rating, specified as cervical spine ROM of “…not greater than 30°”or combined cervical ROM of not greater than 170 degrees.  However, the MEB examiner noted there was full ROM 3 months earlier, evaluations in the STR leading up to the MEB NARSUM noted full cervical ROM and the post separation VA evaluation indicated that the CI reported that he had no neck pain in the year since separation and he had full painless neck ROM noted on examination.  The Board opined that the intervening PT evaluation may have represented a “bad day” for the CI regarding neck pain, but that the evidence in the record did not corroborate that cervical ROM was persistently moderately limited.  The Board also reviewed rating as intervertebral disc syndrome based on incapacitating episodes.  There was one episode of quarters for 2 days noted in the STR in the year before separation, but the specified threshold for a compensable evaluation based on incapacitating episodes is a total duration of incapacitation of at least a week.  The Board also considered if additional disability rating was justified for peripheral nerve impairment due to radiculopathy.  The CI reported symptoms of weakness and paresthesias of the right UE but there were no objective findings on any examination of weakness or sensory deficit and EMG/NCS were normal.  The Board agreed there was no evidence of ratable peripheral nerve impairment that could be recommended for additional or higher rating.  Therefore, the Board agreed that the totality of the evidence in record supports the 10% rating for the neck condition.  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 chronic neck pain 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.  The Board did not surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD were exercised.  In the matter of the chronic neck pain 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 recharacterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140423, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

		
XXXXXXXXXXXXXXXXXX, DAF
President
Physical Disability Board of Review

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, AR20140019389 (PD201401762)

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:

Encl						     XXXXXXXXXXXXXXXXXX
						     Deputy Assistant Secretary of the Army
						          (Review Boards)
						         
CF: 
(  ) DoD PDBR
(  ) DVA