RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02313
BRANCH OF SERVICE:  Army	BOARD DATE:  20150619
SEPARATION DATE:  20041026

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Combat Engineer), medically separated for a chronic neck pain condition.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS) but was authorized to perform an alternate physical fitness test (per PROFILE).  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The MEB forwarded “chronic neck pain” to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other condition was submitted by the MEB.  The Informal PEB adjudicated “chronic neck pain secondary to fracture of the posterior elements of C6” as unfitting, rated 10% with likely application of Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  The CI contends continued pain, numbness, headaches and PTSD.  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 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:

IPEB – Dated 20040901	VA* - (~3 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Neck Pain	5235	10%	Residuals, Cervical C6 Spine Fracture	5235	10%	20041218	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 0	
RATING:  10%	RATING:  10%	
*Derived from VA Rating Decision (VARD) dated 20050124 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Chronic Neck.  In August 2002, the CI was involved in a rollover motor vehicle accident and sustained a neck injury.  Radiographs revealed a non-displaced posterior element (the “ringed” portion of the vertebrae {articular joints and ligaments}, not the vertebral body or disc) fracture of his lower cervical (C-6) spinal vertebra.  Specialty consultation declared that the fracture was stable and a non-surgical treatment approach was applicable via external stabilization.  The CI was placed in a cervical collar, restricted from physical activities, and eventually began a gradual physical therapy (PT) program.  Despite long-term treatment, his neck pain continued.  In October 2003, he was permanently profiled and referred for a MEB.  At the MEB examination on 5 August 2004 (3 months prior to Service separation), the CI endorsed 5/10 constant neck pain exacerbated by “riding in rough vehicles, wearing Kevlar, and upper body exercises.”  The MEB physical examination (PE) noted cervical tenderness and decreased range-of-motion (ROM).  Sensation and motor activity was intact.  There was no comment as to the presence of painful motion.  Repeat radiographs revealed degenerative changes near the prior injured site.  The CI’s diagnosis remained unchanged.  The commander’s statement clearly noted that the CI’s condition prevented him from meeting his MOS lifting and carrying requirements.

At the VA (Neurosurgical) Compensation and Pension examination on 18 December 2004 (2 months after separation), the CI reported continued neck pain without radicular extension of symptoms.  At the time of his examination, the CI was not under the care of medical authorities for management of his neck pain.  The PE revealed mildly decreased and painful motion of the cervical spine.  His diagnosis was noted as, “myofascial cervical pain status post C-6 fracture of the posterior elements with no evidence of radiculopathy, myelopathy, or cervical instability.”  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)	PT/MEB ~3 Mo. Pre-Sep
(20040723) 	VA C&P ~2 Mo. Post-Sep
(20041218) 	
Flex (45 Normal)	40/35/40	45	
Extension (45)	35/40/45	20	
R Lat Flexion (45)	35/35/35	45	
L Lat Flexion (45)	35/35/40	45	
R Rotation (80)	45/60/70	80	
L Rotation (80)	50/55/60	80	
Combined (340)	-	315	
Comment	tenderness	painful motion	
§4.71a Rating	10%	10%	

The Board directed attention to its rating recommendation based on the above evidence.  Both the service and VA rated the neck condition at 10% using the same VASRD code of 5235 (vertebral fracture).  Board members first acknowledged and discussed the varying ROM measurements within the MEB examination of either being equally reproduced or improved with repetition and determined that from a combined ROM standpoint, neither the summation of the lowest measurements or the highest measurements would support the minimum VASRD rating of 10%.  Therefore, Board members agreed that the localized tenderness found on the MEB examination would support a 10% impairment level IAW VASRD §4.71a.  Additionally, the degenerative changes (arthritis) found on X-rays would also support VASRD 5003 criteria, but without “incapacitating episodes” would rate a maximum and total rating equal to the current 10%.  There were no available alternative or analogous coding options which are applicable and or advantageous to the CI’s current 10% rating.  There also was no evidence of a ratable neurologic impairment or documentation of VASRD-defined incapacitating episodes in this case which would provide for additional or higher rating.  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:  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 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 20140522, 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, AR20160000282 (PD201402313)

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