RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03426
BRANCH OF SERVICE:  Army	BOARD DATE:  20150626
SEPARATION DATE:  20070430

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated National Guard E-5 (Indirect Fire Infantryman) medically separated for degenerative disc disease (DDD) of the neck.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty.  He was issued a permanent U3 profile and referred for a Medical Evaluation Board (MEB).  The “chronic neck pain due to degenerative disc disease of the cervical spine” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other condition was submitted by the MEB.  The Informal PEB (IPEB) adjudicated “degenerative disc disease resulting in chronic neck pain” as unfitting, rated 10% with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI appealed to the Formal PEB, which affirmed the IPEB finding and rating, and, responding to counsel, determined that headaches were not unfitting.  The CI made no further appeals and was medically separated.

CI CONTENTION:  “Please consider all conditions.”

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:

FPEB - Dated 20070403	VA* - (~3 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Degenerative Disc Disease Resulting in Chronic Neck Pain…	5242	10%	DDD of the Cervical Spine	5010-5237	10%	20070731	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 9 (equals SC, NSC & deferred)	
RATING:  10%	RATING:  40%	
*Derived from VA Rating Decision (VARD) dated 20070809 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:  The Board noted that the CI appealed to the PEB for inclusion of a headache condition.  This was not forwarded by the MEB nor adjudicated by the PEB.  The PEB did comment on the headache condition, but primarily to note that it had not been discussed by the MEB.  Accordingly, the headache condition is also outside the purview of the Board.

DDD of the Neck Condition.  The CI was activated on 15 October 2006 and during training, developed neck spasm on 9 November 2006.  He was treated with an anti-inflammatory medication and a muscle relaxant with persistent pain.  An X-ray on 13 November 2006 showed both DDD and degenerative joint disease.  He was also noted to have an incidental scoliosis of the thoracic spine.  A magnetic resonance imaging showed multilevel DDD.  He was then referred to neurology.  He reported the acute onset of pain a week earlier while firing his weapon.  He denied a history of prior neck pain.  On examination, he had spasm and held his neck stiffly.  He was also noted to have some sensory loss.  Electrodiagnostic studies on 30 November 2006 showed the presence of a bilateral carpal tunnel syndrome (CTS), but no evidence of a cervical radiculopathy.  During this evaluation, the CI was also treated for a headache syndrome which was aggravated by the neck pain.  At an evaluation on 21 December 2006, he was noted to have full range-of-motion (ROM) of the neck and a normal gait.  His neurological examination was normal other than slight weakness of the triceps (not present previously).  Formal ROM testing was accomplished in physical therapy (PT) on 18 January 2007 and is charted below.  A week later in physical medicine, he had full, but painful, ROM without weakness.  Tenderness of the paraspinal muscles was present.  The neurological examination was normal.  The narrative summary noted above history and cited the MEB examination and the PT ROM.  At the MEB examination on 24 January 2007, the CI did not report either neck or headache problems.  On the MEB physical examination, the spine was noted to be normal.  The CI was placed on quarters for 24 hours on 15 March 2007 for migraines and neck pain.  Incapacitation from the neck condition was not otherwise documented.  At the VA Compensation and Pension examination performed on 31 July 2007, 3 months after separation, the CI reported the onset of pain while firing a weapon the prior October.  He also reported that he had received injections; this was not previously recorded.  His pain did not impair the activities of daily living or his occupation (policeman), but the use of a bullet proof vest did aggravate his pain.  On examination, there was neither tenderness nor spasm.  The ROM showed some limitations secondary to pain as charted below.  His gait and posture were normal.  The neurological examination showed signs of CTS, but not of radiculopathy.  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)	MEB ~3 Mo. Pre-Sep	VA C&P ~3 Mo. Post-Sep	
Flex (45 Normal)	30	45	
Combined (340)	305	280	
Comment	Limited by pain	Painful motion	
§4.71a Rating	20%	10%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB and VA both rated the neck at 10%, but used the codes 5242 (degenerative arthritis of the spine) and 5010-5237 (traumatic arthritis-cervical strain), respectively.  The Board noted that all three of these codes use the same rating criteria and none provided an advantage over the others.  The PT ROM measurements support a 20% rating whereas those by the VA support a 10%.  The Board noted that the CI was found to have normal ROM in clinical visits both before and after the PT measurements.  Also, following separation, the CI reported no limitations from the neck pain other than pain with the wear of a bullet-proof vest.  The Board determined that the VA measurements were more reflective of the permanent level of disability at separation and were assigned a higher probative value for rating purposes.  Tenderness was present which also supports a 10% evaluation.  While spasm was initially present, it resolved with treatment and was not documented proximate to separation.  Regardless, posture and gait were normal.  Incapacitation was not documented other than quarters one time for neck pain and a migraine headache.  The Board also determined that the evidence does not support the presence of an unfitting radiculopathy at separation.  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 DDD with neck pain condition.

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 DDD resulting in chronic neck pain 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 20140627, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB

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

06 JUl 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 XXXXXXXXXX, AR20160003328 (PD201403426)

I have reviewed the enclosed Department of Defense Physical Disability Board of
Review (000 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