RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03686
BRANCH OF SERVICE:  Army  	SEPARATION DATE:  20051116

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated Reserve, E5, Wheeled Vehicle Mechanic, medically separated for “chronic neck stiffness pain …,” with a disability rating of 20%.  

CI CONTENTION:  “Neck condition, lower back condition, left knee condition, hemorrhoids, deviated septum.”  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 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 - 20050819	VARD - 20061026	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Neck Stiffness Pain…	5237	20%	Degenerative Arthritis, Cervical Spine	5242	20%	20060421	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Chronic Neck Stiffness Pain.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s neck condition began in February 2003, after his military vehicle was struck by a civilian car.  The CI had an additional neck trauma in November 2004 with cervical compression and 10-15 minutes of paralysis from the neck down.  Radiographs documented two level cervical disk protrusion and central canal narrowing at one level.  The CI complained of neck pain and tingling and pain down his arm (paresthesias).  Despite treatment, including physical therapy (PT) the CI’s neck condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and was referred for an MEB.  

The 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)	PT ~5 Mo. Pre-Sep	VA C&P ~5 Mo. Post-Sep	
Flex (45 Normal)	20	20	
Combined (340)	195	170	
Comment	Pain with motion	Painful motion; tenderness; muscle spasm with antalgic gait; ROM unchanged with repetition	
§4.71a Rating	20%	20%	

At the time of the neurosurgery clinic appointment on 9 Feb 2005 (3 months prior to separation), the CI reported his symptoms had resolved and he had no neck or arm pain.  The specialist recommended surgery to prevent increased risk of future spinal cord injury from trauma and the CI reasonably declined surgery.  At the MEB NARSUM exam on 13 Apr 2005 (7 months prior to separation), the CI reported his symptoms including the neck and arm pain had completely resolved.  The physical examination showed normal upper extremity strength without neurologic deficits.  There was cervical spine stiffness with ROMs as charted above.  On 31 May 2005, the CI had a magnetic resonance imaging study for new onset of left arm paresthesias.  Radiographs showed posterior disc bulges at C5-6 and C6-7 with straightening of normal cervical lordosis, which was “likely secondary to spasm.”  The CI had an additional cervical trauma in June 2005 when his vehicle was struck from behind.  Consults indicated unchanged symptoms and radiographs documented no new cervical spine pathology.  

At the VA Compensation and Pension (C&P) examination on 21 April 2006 (5 months after separation), the CI reported constant neck pain with shooting pain up to his head around three times per week.  The CI reported occasional flare-ups for which he did not take medication; stiffness lasting all day but no radiation; no bowel or bladder incontinence; and no use of a brace.  Gait was steady with no limitation to activities of daily living.  On examination, strength and neurologic testing was normal.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 20% rating under the 5237 code (cervical strain), citing ROM limitations.  The VA also assigned a 20% rating using the 5242 code (degenerative arthritis of the spine) citing ROM greater than 15 degrees but not greater than 30 degrees; or combined ROM not greater than 170 degrees.  The Board agreed that a 20% rating, but no higher, was justified for limitation of flexion (greater than 15 degrees but not greater than 30 degrees).  There was no evidence of intervertebral disc syndrome resulting in incapacitating episodes requiring bed rest prescribed by a physician to warrant consideration of rating under the alternate VASRD formula based on incapacitating episodes due to intervertebral disc syndrome.  

Although the CI experienced radiating pain, there was no objective evidence of a radiculopathy or functional impairment with a direct impact on fitness.  While the CI may have experienced radiating pain from the neck condition, this is subsumed under the general spine rating criteria, which specifically states “with or without symptoms such as pain (whether or not it radiates).”  There is no evidence in this case that there was radiculopathy with associated functional impairments separately functionally impairing.  The Board therefore concluded that additional disability rating was not justified on this basis.  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 back condition.

BOARD FINDINGS:  In the matter of the “Chronic Neck Stiff 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.  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 20140804, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR Commander

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation
for XXXXXXXXXXXXXXXXXXXXXXX AR20160009313 (PD201403686)

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