RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01895
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20061208

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E7, Maintenance Supervisor, medically separated for “chronic neck pain,” with a disability rating of 0%.

CI CONTENTION:  His neck condition along with bilateral shoulder condition, which were documented in his service medical record continue to worsen and affect his daily life.  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 - 20061114	VARD - 20070521	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Neck Pain	5241	0%	Degenerative Disc Disease of the Cervical Spine	5242	10%	20070328	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Chronic Neck Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s chronic neck pain condition began in 2002 after a motor vehicle accident.  He reinjured his neck in April 2005 after falling off of a dirt bike.   A diagnostic imaging (MRI) study in June 2006 showed degenerative disc disease, herniated intervertebral discs at C4-5, and nerve root impingement on the left at C6-7.  Cervical fusion and discectomy surgery was performed on 7 October 2005.  Following surgery further treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “C4-5 herniated nuclear pulposus status post discectomy and anterior fusion,” and “herniated nucleus pulposus and degenerative disc disease C6-C7 without radicular symptoms,” for PEB adjudication.  During the MEB examination dated 8 September 2006, 3 months prior to separation, the CI reported neck pain rated at 2-3/10 scale.  The pain was aggravated by doing physical training and excessive activities, but did not affect his daily activities.  He experienced neck pain when wearing a Kevlar helmet and rucksack and was not able to participate in airborne activities.  Physical examination showed normal gait, sensation, and reflexes.  Cervical spine ROM was limited by pain to 20 degrees flexion (45 degrees normal), 25 degrees extension (45 degrees normal), and 30 degrees bilateral lateral flexion (45 degrees normal).  At the 28 March 2007 VA Compensation and Pension (C&P) evaluation, performed 4 months after separation, the CI reported neck pain that radiated to his left shoulder and left leg.  The pain prevented him from chores, sports, and exercise.  Physical examination showed normal gait, spinal curvature, sensation, and reflexes.  There was no muscle spasm, tenderness, or radicular findings.  Cervical spine ROM was full, but painful.   A diagnostic imaging (X-ray) study in March 2007 showed degenerative disc disease of the C6 and C7 discs.  There nerve impingement on the left at C6 and C7.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic neck pain condition 0% rating coded 5241 (spinal fusion), citing mechanical loss of motion.  The VA assigned a 10% rating coded 5242 (degenerative arthritis of the spine) for limitation of motion due to pain.  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 the MEB NARSUM examination.  The Board also considered if additional disability rating was justified for peripheral nerve impairment due to radiculopathy.  The CI had a herniated disc with radicular pain treated with surgery, and there were symptoms of radiating pain documented in the treatment records; however, examinations indicated normal strength, reflexes, and the sensory changes did not affect his job.  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 the nerve involvement, this 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 this case 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, and considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 20% for the chronic neck pain condition, coded 5241.  

BOARD FINDINGS:  In the matter of the chronic neck pain condition, the Board unanimously or majority 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 recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Neck Pain	5241	20%	
COMBINED	20%	

The following documentary evidence was considered:
Exhibit A.  DD Form 294, dated 20140530, 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 XXXXXXXXXX, AR20160011079 (PD201401895)

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:

CF: 
(  ) DoD PDBR
(  ) DVA