RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03498
BRANCH OF SERVICE:  Army	BOARD DATE:  20150611
SEPARATION DATE:  20040204

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated Reserve E-4 (Automated Logistical Specialist) medically separated for neck pain.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty.  The profile allowed for an alternate aerobic event to satisfy physical fitness standards.  He was issued a permanent U3 profile and referred for an Medical Evaluation Board (MEB).  Chronic neck pain secondary to congenital spine stenosis was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other condition was submitted by the MEB.  The Informal PEB adjudicated his chronic neck pain as unfitting, rated 10% with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI appealed but did not request a formal hearing.  The US Army Physical Disability Agency affirmed the PEB’s findings and rating.  The CI made no further appeal 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:

IPEB – Dated 20031104	VA* - Service Treatment Records (STR)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Neck Pain…	5238	10%	Fracture C3, Subluxation C2/3, C3/4, & C4/5	5290-5242	20%	STR	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 1	
RATING:  10%	RATING:  20%	
*Derived from VA Rating Decision (VARD) dated 20040708 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Neck Condition.  On 23 August 1997, the helmeted CI was struck on the head and neck by a falling tent pole during field training.  He was admitted to orthopedics that day for observation due to concern of a possible fracture on X-ray.  Neurologically, he was intact.  Subsequent review of the X-rays by a neurosurgeon showed that the X-ray changes were congenital and he was diagnosed with Klipple-Feil syndrome (a congenital fusion of several of the cervical vertebrae with a reduction in the range-of-motion [ROM] of the neck).  Degenerative disc disease (DDD) and degenerative joint disease (DJD) were also noted; the action officer observed that these are common in this condition.  An orthopedic note dated 5 January 1999 recommended the CI for MEB.  The MEB narrative summary (NARSUM) noted continued pain since he was injured by the tent pole.  The MEB was not completed, apparently due to non-compliance by the CI.  He continued to participate in Guard activities despite a U3 profile until re-identified for MEB in 2003.  A magnetic resonance imaging on 21 May 2003 again showed multi-level DDD and DJD in the neck.  He was evaluated in neurosurgery on 17 June 2003 and found to have congenital spinal stenosis as well as foraminal stenosis (the outlets in the spine for the nerve roots) without radiculopathy.  Surgery was not recommended.  A primary care note on 29 July 2003 indicated that the CI wanted to finish up his 20 years for retirement.  A note by the MEB physician on 22 September 2003 noted that the ROM was reduced in some planes as documented below.  The NARSUM was dated 22 September 2003 and noted that the initial MEB had been discontinued due to non-compliance by the CI.  Neither painful motion nor incapacitation was documented.  He was unable to do sit-ups, heavy lifting, or overhead activity.  The ROM was reduced in some planes as documented below.  The neurological examination was normal and muscle atrophy was absent.  He was thought to have a congenital neck condition without permanent service aggravation.  An after separation note from the VA dated 10 March 2004 noted that there was some decrease in the ROM of the neck mainly with side-bending to the right (greater than left).  On 27 April 2004, it was noted that the cervical ROM was fair/good.  On 14 December 2004 in a VA primary care clinic his neck was noted as “supple” implying no or minimal loss of motion.  There was no additional ROM information available for review which was within the 12 month window after separation for higher probative value for rating purposes at separation.

The VA Compensation and Pension examinations were not until 15 and 36 months after separation.  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)	NS ~7 Mo. Pre-Sep	MEB ~4 Mo. Pre-Sep	
Flex (45 Normal)	----	45 (55)	
Extension (45)	20	35	
R Lat Flexion (45)	60	35	
L Lat Flexion (45)	60	30	
R Rotation (80)	60	80	
L Rotation (80)	20	50	
Combined (340)	---	285	
Comment	Incomplete; values may be transposed	Painful motion not document	
§4.71a Rating	---	10%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the neck at 10% using the code 5238 (spinal stenosis).  The VA rated the neck at 10% initially in 1997 and then 20% in 1998 using the old VASRD code 5290 (limitation of motion of the cervical spine).  This rating was continued in 2000 and 2005 after re-evaluation, but based on evidence not proximate to separation.  Absent evidence of incapacitating episodes, limitation of cervical forward flexion 30 degrees or less or combined cervical ROM to 170 degrees or less, muscle spasm or guarding with abnormal spinal contour, the Board determined that a higher 20% rating is not supported under the VASRD general spine rating formula.  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 chronic neck pain.  The Board noted that there was no evidence of a separately unfitting radiculopathy and 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.  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 20140505, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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 XXXXXXXXXXXXXXXXXXXXXXX AR20160003190  (PD201403498)

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: