RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03324
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20030406

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E-5, Health Care Specialist, medically separated by the Informal Physical Evaluation Board (PEB) for “chronic pain, neck and upper back” with a disability rating of 0%.

CI CONTENTION:  “Please consider all conditions.”  The applicant’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 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 – Dated 20030108	VARD - 20030729	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain, Neck and Upper Back	5099-5003	10%	Cervical Spine Condition with Myofascial Pain Syndrome	5299-5290	10%	20030729	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Chronic Neck and Upper Back Pain.  The CI initially presented with neck pain in February 2001 after a fall.  She was diagnosed with acute cervical strain and treated with quarters, a cervical collar, and narcotic medications.  The CI continued to report neck pain with radiation to the upper back and shoulders.  A computed tomography study performed 20 March 2001 was normal.  The CI was evaluated by Physical Medicine and Rehabilitation and diagnosed with chronic myofascial pain syndrome.  The CI underwent physical therapy and multiple steroid and botulin injections with pain improvement, but not resolution.  At the narrative summary (NARSUM) examination approximately 7 months prior to separation the CI reported persistent neck and upper back pain.  The physical examination demonstrated decreased cervical range-of-motion.  A service treatment note dated 17 December 2002, approximately 4 months prior to separation documented a physical finds of a supple neck without rigidity or pain with flexion or extension.  At the VA Compensation and Pension (C&P) examination performed 4 months after separation, the CI reported relief of the neck pain with botulinum toxin injection.  The physical examination demonstrated a supple neck, normal posture, mild cervical spasm, and decreased cervical range-of-motion (ROM) with additional limitation of motion secondary to pain and lack of endurance.  A diagnosis of myofascial pain involving the cervical spine was rendered.
The Board directed attention to its rating recommendation based on the above evidence.  The PEB combined the neck and upper back conditions under a single Service disability rating.  IAW DoDI 6040.44 if the PEB combined adjudication is not VASRD compliant, each condition subsumed under the single Service disability rating must be reasonably justified as separately unfitting in order to remain eligible for Service rating.  The Board’s initial charge in this case was directed at determining if the PEB’s combined adjudication was justified in lieu of separate ratings.  Service treatment providers and the VA examiner noted a diagnosis of cervical myofascial (muscular) pain. The Board noted that radiographic evaluations were negative for bony or other cervical spine pathology; therefore, the Board determined that the cervical and upper back pain (cervical myofascial pain) represented one Service disability and were not reasonably justified as separate unfitting conditions.  The PEB and VA rated the chronic neck and upper back pain condition at 10%, coded 5099-5003 (analogous to degenerative arthritis) and 5299-5290 (analogous to slight cervical spine limitation of motion). The Board then considered if the evidence supported a higher than 10% rating.  Board members agreed that evidence most proximate to separation demonstrated slightly decreased, but supple cervical ROM with “some cervical spasms” and did not rise to the level of moderate cervical limitation of motion for a 20% 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 and upper back 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:  In the matter of the chronic neck and upper back 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.  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 20140614, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

		
SAMR-RB

Jul 14 2016

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 XXXXXXXXXXAR20160005134 (PD201403324}

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
( ) OVA