RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02919
BRANCH OF SERVICE:  Army	BOARD DATE:  20150707
SEPARATION DATE:  20050213 

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5 (Military Police) medically separated for chronic neck pain.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS).  He was issued a permanent U3 profile and referred for a Medical Evaluation Board (MEB).  The condition, characterized as “chronic neck pain and right upper extremity paraesthesias secondary to cervical degenerative disc disease and cervical spondyloarthropathy (C3 or C7)”was forwarded 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 cervical degenerative disc disease and cervical spondyloarthropathy, status post posterior cervical foraminotomy, without significant neurologic abnormality,” as unfitting, rated 10%,  with likely application of the Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.  

CI CONTENTION:  The CI requested that the Board review all of his conditions.  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 20041214	VA* - (~2 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Neck Pain…	5237	10%	Cervical Degenerative Disc Disease…	5242	10%	20050411	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 8 (equals SC, NSC & deferred)	
RATING:  10%	RATING:  10%	
*Derived from VA Rating Decision (VARD) dated 20060809 (most proximate to date of separation (DOS)).  

ANALYSIS SUMMARY:  

Chronic Neck Pain Condition.  Treatment records evidence that the CI presented with neck pain in July 2003 after an injury.  He was treated for cervical neck strain with pain medications and chiropractic care.  He subsequently developed right upper extremity numbness and tingling. An electromyogram dated 15 September 2003 documented findings consistent with right lower trunk brachial plexopathy.  The CI underwent cervical spine surgery (posterior cervical foraminotomy C6-7) on 20 November 2003 for cervical derangement with upper extremity symptoms.  A neurosurgery note, one month after surgery, documented improvement in his left shoulder range-of-motion and pain relief.  The examiner noted that he had good strength in his upper extremities and an intact sensory examination.  Despite surgical intervention and post-operative physical therapy, the CI continued to report chronic neck pain aggravated by wearing Kevlar and carrying his ruck sack.  The narrative summary (NARSUM) noted continued reports of neck pain and right upper extremity paresthesia.  The physical examination is documented in the chart below.  At the VA Compensation and Pension (C&P) exam performed approximately 2 months after separation, the CI reported cold sensation in his arms and hands; problems looking right and left; pain in the right hand and arm, cracking of his neck; and decreased neck motion.  He also reported some neck spasms with two incapacitating episodes of neck pain.  The physical examination is documented in the chart below.  The goniometric range-of-motion (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)	PC ~14 Mo. Pre-Sep
	DD 2808 ~6 Mo. Pre-Sep
	MEB ~3 Mo. Pre-Sep
	VA C&P ~2 Mo. Post-Sep
	
Flex (45 Normal)	45	50	45	Chin to Chest	
Extension (45)	45	45	45	#	
R Lat Flexion (45)	#	45	45	#	
L Lat Flexion (45)	#	45	45	#	
R Rotation (80)	60	#	70	45	
L Rotation (80)	60	#	70	45	
Combined (340)	#	#	320	#	
Comment	--	Cervical spine not tenderness to palpation	No tenderness to palpation; well healed cervical scar.	No neck stiffness, able to put his chin to his chest, neck arm and shoulder pain with lateral motion of the head, normal upper extremity muscle strength.  	
§4.71a Rating	0%	0%	0%	10%	

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB adjudicated the chronic neck pain condition as unfitting with a disability rating of 10%; coded 5237 (Cervical Strain).  The VA also rated the chronic neck pain condition at 10%; coded 5242 (Degenerative arthritis of the spine).  The Board considered if the evidence supported a higher than 10% rating.  There was no evidence of forward flexion of the cervical spine greater than 15 degrees but not greater than 30 degrees; combined range of motion of the cervical spine not greater than 170 degrees; or muscle spasm or guarding severe enough to result in an abnormal gait or spinal contour for a 30% rating.  The Board then deliberated if the right upper extremity radiculopathy was separately unfitting and ratable.  The Board’s threshold for adding unfitting associated conditions for rating requires a preponderance of evidence, but remains adherent to the DoDI 6040.44 “fair and equitable” standard.  The NARSUM and VA examinations documented normal right upper extremity strength.   The commander’s statement focused only on the profiled limitations due to chronic neck pain, there was no mention of the right upper extremity function impairments interfering with the CI’s ability to his duties.  The Board adjudged that that there was not a preponderance of evidence that the right upper extremity radiculopathy condition caused duty limitations.  The Board concluded therefore that the right upper extremity radiculopathy condition could not be recommended for additional disability 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 chronic neck pain condition was appropriately recommended in this case.  The Board concluded therefore that this condition could not be recommended for additional disability rating.  

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.  In the matter of the contended right upper extremity radiculopathy condition, the Board unanimously agrees that it cannot recommend it for additional disability rating.  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 20140612, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

DEPARTMENT OF THE ARMY
ARMY REVIEW BOARDS AGENCY
251 18TH STREET SOUTH, SUITE 385
ARLINGTON, VA 22202-3531

SAMR-RB

MEMORANDUM FOR Commander, US Army Physical Disability Agency
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557

JUL 2016

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation
for XXXXXXXXXX, AR20160003491 (PD201402919)

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