RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02957
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20051205

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Indirect Fire Infantryman, medically separated for “chronic neck pain” with a disability rating of 10%.

CI CONTENTION:  “Please consider all conditions.”  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 based upon a 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 - 20051101	VARD - 20070110	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Neck Pain	5237	10%	Cervical Strain	5237	20%	20061130	
PTSD with Depressive Features	Not Unfitting	PTSD Claimed as Adjustment Disorder and Insomnia	9411	30%	20061130	
History of Gastric Ulcers Secondary to NSAID use	Not Unfitting	Gastric Ulcer	7304	0%	20061130	
Chronic Tension Headaches Secondary to Neck Pain	Not Unfitting	Tension Headaches	8199-8100	0%	20061130	
History of Elevated Blood Pressure without Diagnosis of Hypertension	Not Unfitting 	Hypertension	NSC	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Chronic Neck Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s neck condition began in Iraq in November 2004 after a Humvee accident.  He developed neck pain treated with non-steroidal anti-inflammatory (NSAID) pain medication.  Neuroimaging showed degenerative disc disease and questionable arthritis in his cervical spine.  Pain persisted despite physical therapy, steroid injections, and “electrical shock.”  He was referred to a pain specialist.  No surgery was indicated.  He reported daily 7/10 baseline pain which increased to 10/10 twice per week, worsened by most physical activities.  He had received multiple medications with relief with over-the counter pain medications.  He denied distal extremity radicular symptoms and pain was mostly on the right side.  He had a history of neck pain prior to entering the service, though not recorded on entrance physical.  Prior x-rays were negative and the CI denied significant neck pain prior to service. 

At the VA Compensation and Pension (C&P) orthopedics examination performed 12 months after separation, the CI reported throbbing pain from the base of the neck to the posterior aspect of both shoulders, worse over the right shoulder than the left.  He denied radicular symptoms or incapacitating pain or flare-ups that required bed rest or hospitalization.  Examination showed normal contour, negative swelling and moderate paraspinal muscle spasm from occiput to the fourth thoracic vertebra.  There was pain to palpation from C4-5 to T2.  Forward flexion was 40 degrees (normal 45) and extension was 40 degrees (normal 45.)  Upper extremity motor function was rated 5/5.  Reflexes and sensory findings were normal.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the neck condition 10% coded 5237 (cervical strain), citing tenderness.  The VA rated the neck condition 20% also coded 5237 based on the VA C&P examination a month after separation, citing muscle spasms.  The Board noted that although muscle spasms were present, the C&P examination noted the spinal contour was normal, thus not meeting criteria for the 20% rating.

The Board also deliberated if additional disability was justified for peripheral nerve impairment.  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.  Pain (whether or not it radiates), stiffness, or aching is rated under the general formula for the spine and was considered in the 5237 rating above.  There was insufficient evidence in this case of functional impairment attributable to peripheral neuropathy that adversely impacted duty performance.  The Board therefore concluded that no peripheral nerve (radiculopathy) condition could be recommended for additional disability rating.   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 neck pain condition.  

Contended PEB Conditions PTSD, Gastric Ulcers, Tension Headaches, Elevated Blood Pressure
The Board’s main charge is to assess the fairness of the PEB’s determination that The Board’s main charge is to assess the fairness of the PEB’s determination that PTSD, Gastric Ulcers, Tension Headaches, Elevated Blood Pressure were not unfitting.  

PTSD With Depressive Features.  The Psychiatry Addendum noted the CI experienced stress and depression because of the killing involving his comrades and Iraqi insurgents.  He developed nightmares and intrusive memories.  He felt discouraged that the pain and injury would interfere with future plans.  A diagnosis of PTSD was rendered with a Global Assessment of Functioning (GAF) score of 65 (mild symptoms, impairment.)  His appetite was improving and he had relationships of a meaningful nature.  He received a S2 profile but the examiner opined that his PTSD itself was not unfitting.  The commander did not implicate a mental health condition as an impairment to performance.
The gastric ulcers, tension headaches, elevated blood pressure conditions were not profiled or implicated in the commander’s statement and were not judged to fail retention standards.  All were reviewed and considered by the Board.  There was no performance based evidence from the record that any of these conditions significantly interfered with satisfactory duty performance.  After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the PTSD, gastric ulcers, tension headaches, and elevated blood pressure contended conditions and so no additional disability ratings are recommended.

BOARD FINDINGS:  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 PTSD, gastric ulcers, tension headaches, elevated blood pressure conditions, the Board unanimously recommends no change from the PEB determinations as not unfitting.  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 20140618, 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, AR20170000948 (P201402957)

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