RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03745
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070620

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Light Wheel Vehicle Mechanic, medically separated for “chronic neck pain” and “chronic pain, right shoulder,” rated 10% and 10%, respectively, with a combined disability rating of 20%.

CI CONTENTION:  The CI contends that his PTSD, carpal tunnel, thoracic outlet syndrome, plantar fasciitis, and gastritis were not considered by the PEB.  He also contends that his neck and shoulder conditions were combat related.  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 - 20070530	VARD - 20071120	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Neck Pain…	5299-5237	10%	Cervical Strain with Small Disc Bulge	5237	0%	20070817	
Chronic Pain, Right Shoulder…	5099-5003	10%	Right Shoulder Sprain with SLAP Lesion	5201	0%	20070817	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Chronic Neck Pain.  According to service treatment records (STR), the Medical Evaluation Board (MEB) narrative summary (NARSUM), and VA examinations, the CI’s neck condition began in May 2006 after a motor vehicle accident.  Radiographic studies (MRI) in March 2007 showed degenerative disc disease with a bulging intervertebral disc at C6-7 and straightening of the spine.  At the time of the physical therapy clinic appointment on 15 March 2007, 3 months prior to separation, the CI reported that his neck pain was aggravated by sleeping, wearing body armor or wearing a Kevlar helmet.  On examination he was noted to have full active motion of the cervical spine and a normal gait.

At the time of the orthopedic clinic appointment on 1 May 2007, the examiner recorded that the CI’s neck pain was paraspinal in nature with no radicular symptoms or myelopathy.  The CI had “pain with range of motion [ROM] or wearing a helmet.”  On examination he had tenderness and painful motion.  There was no indication of limited motion nor were ROM measurements recorded.  Electrodiagnostic studies, 17 May 2007, were negative for radiculopathy.  Evaluation by orthopedics concluded with a diagnosis of cervicalgia.  There was no surgical indication.  Despite treatment, the neck condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for a MEB.  The MEB forwarded “cervicalgia” for PEB adjudication.

The physical therapy ROM study for MEB, dated 21 May 2007, showed painful limited motion and forward flexion recorded at 40 degrees (45 normal) and extension of 45 degrees (normal).  There was no change with repetitive motion.  Pain was elicited in all planes except extension.  The MEB NARSUM examination on 22 May 2007, a month prior to separation, noted complaints of pain with wearing rucksack, body armor, and helmet.  Physical examination showed tenderness to palpation of the paraspinal muscles.  

At the 17 August 2007 VA Compensation and Pension (C&P) examination, performed 2 months after separation, the CI reported neck pain aggravated by prolonged driving or prolonged laying on back.  Physical examination showed normal ROM of 45 degrees of flexion and extension, normal gait and spinal contour, no paraspinal muscle spasm, no tenderness to palpation, normal reflexes, normal strength, and normal sensation.  There was no limitation or pain noted with repetitive motion.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the neck condition 10% under an analogous 5237 code (cervical spine strain), citing “cervical ROM limited by pain with localized tenderness”.  The VA assigned a 0% rating using the 5237 code citing “forward flexion of the cervical spine greater than 40 degrees; or, combined range of motion of the cervical spine greater than 335 degrees.”

The Board agreed that a 10% rating, but no higher, was justified for limitation of flexion greater than 30 degrees but not greater than 40 degrees and/or combined ROM greater than 170 degrees but not greater than 335 degrees reported on the physical therapy examination proximate to separation.  There was no muscle spasm or guarding severe enough to result in an abnormal gait or spinal contour, thus the next higher 20% rating was not justified.  There was no evidence of intervertebral disc syndrome (IVDS) which resulted in incapacitating episodes requiring physician-prescribed bed rest to warrant consideration of rating under the alternate VASRD formula for IVDS.  There was no evidence of an associated unfitting radiculopathy for consideration of a separate peripheral nerve rating.  After due deliberation, and 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 condition.

Right Shoulder Condition.  According to service treatment records and the MEB NARSUM, the right hand dominant CI injured his right shoulder in May 2006.  Radiographic studies in March 2007 showed a “probable SLAP [superior labrum anterior and posterior] lesion.”  At the time of the physical therapy clinic appointment on 15 March 2007, 3 months prior to separation, the CI reported that his shoulder pain was aggravated by standing at parade rest, saluting, close-hand push-ups, sit-ups, and overhead activities.  On examination he was noted to have full active motion of the right shoulder with palpable crepitus.  At the time of the orthopedic clinic appointment on 1 May 2007, the examiner recorded that the CI’s shoulder pain was “associated with popping and grinding and feeling of instability.”  On examination he had painful motion as well as limited forward flexion, but the degree of limitation was not included in the examination findings.  There was also tenderness to palpation, but no instability.  There was no surgical indication, and conservative treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “shoulder sprain superior glenoid labrum lesion right” for PEB adjudication. 

The ROM examinations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.  

Right Shoulder ROM
(Degrees)	PT ~3 Mo. Pre-Sep
	PT ~1 Mo. Pre-Sep
	VA C&P ~2 Mo. Post-Sep
	
Flexion (180 Normal)	Full	180	180	
Abduction (180)	Full	180	180	
Comments	Crepitus	- 	-	
§4.71a Rating	0%	0%	0%	

At the time of the physical therapy ROM study for MEB, dated 22 May 2007, the examination showed full active pain-free motion as noted in the chart above.  There was no change with repetitive motion.  

The MEB NARSUM examination on 22 May 2007, 1 month prior to separation, noted complaints of pain with “push-ups, carrying a weapon for extended periods of time, working as a mechanic for extended periods of time, holding more than 25 pounds,” and “difficulty changing tires.” There were no significant examination findings listed on the NARSUM, but DD Form 2808 indicated “slight decreased ROM of the right shoulder.”  The DD Form 2808 also indicated normal strength, but the right shoulder was slightly weaker than the left. 

At the 17 August 2007 VA Compensation and Pension (C&P) examination, performed 2 months after separation, the CI reported shoulder pain with weekly locking episodes, instability, and giving way.  He also reported pain with quick movements and painful motion.  Physical examination showed normal ROM as indicated in the chart above with no evidence of pain.  There was no limitation or pain with repetitive motion.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under an analogous 5003 code (degenerative arthritis), citing slight and constant pain IAW the US Army Physical Disability Agency’s pain policy.  The VA assigned a 0% rating using the 5201 code (arm limitation of motion), citing “normal ranges of motion of the right shoulder.”  There was no pain and no additional loss of motion with repetitive use. 

The VASRD §4.71a (code 5201, arm limitation of motion) threshold for a rating for ROM impairment is “at shoulder level” (90 degrees from the side), and the ROM in evidence demonstrated motion above this level.  There was no malunion or recurrent dislocation of the humerus to justify a rating under the 5202 code (humerus, other impairment of); and no nonunion with loose movement of the clavicle to warrant the next higher 20% rating under the 5203 code (clavicle or scapula, impairment of).  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 right shoulder condition.

BOARD FINDINGS:  In the matter of the neck condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the right shoulder 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 20140815, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB

MEMORANDUM FOR Commander

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation
for XXXXXXXXXXXXXXXXXXXX, AR20160011759 (PD201403745)

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