RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03982
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060518

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Cavalry Scout, medically separated for “chronic neck pain secondary to degenerative disc disease,” with a disability rating of 0%.

CI CONTENTION:  The applicant contends that his migraine headaches have worsened; that his current job is hard to do because of the numbness in his hands; and that his VA disability does not cover the cost of special equipment that he has to purchase to treat his disability.  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 based upon a 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 - 20060419	VARD - 20060831	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Neck Pain Secondary to Multilevel Degenerative Disc Disease (DDD)	5237	0%	DDD, Cervical Spine with Headaches and Radiculopathy, Bilateral Upper and Lower Extremities	5238-5242	10%	20060623	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Chronic Neck Pain Secondary to Multilevel Degenerative Disc Disease.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s neck condition began in November 2003 after straining his neck.  X-Rays were normal.  He later reinjured his neck in August 2005 while functioning as a “gunner” in a tactical vehicle.  A 4 October 2005 MRI showed disk protrusion at C5-C6 and disk bulges at C6-C7.  There was no surgical indication.  Despite treatment, the cervical spine condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for to the MEB.  The MEB forwarded “cervicalgia with herniated disk at C5-C6 and disc bulges at C4-C5 and C6-C7” for PEB adjudication.  

At the time of the orthopedic examination on 23 November 2005, 8 months prior to separation, the CI reported intermittent bilateral hand numbness and increased tension in his neck muscles that caused tension headaches.  On examination his range of motion (ROM) was limited.  He had 30 degrees of extension (normal 45) and he could forward flex to within “one fingerbreadths distance from the chin to sternum” (equivalent to at least 45, which is normal).  Lateral rotation was 60 degrees (normal 80).  There was no tenderness to palpation of the cervical spine.  There was a slight loss of motor strength in his bilateral triceps (4+/5), but he had normal strength in all of his other upper extremity muscles.  He had normal sensation and reflexes.  The examiner noted that within 3-4 seconds of neck being flexed, the CI developed tingling in his hands followed by numbness.  

At the MEB examination (recorded on DD Form 2807 Report of Medical History and DD Form 2808 Report of Medical Examination) dated 27 December 2005, 5 months prior to separation, the CI reported that his “arm[s] and hands along with feet, go numb [due] to [his] neck injury.”  Physical examination was unremarkable.  At the time of the neurology clinic appointment on 28 February 2006, 3 months prior to separation, the CI reported “left posterior neck pain” that “occasionally [radiated] into the trapezius and scapula area, as well as into the back of the head on the left.”  He denied having radicular pain.  He also denied having numbness, paresthesias, or weakness in his arms.  On examination he had normal motor strength, reflexes and gait.  

The MEB NARSUM examination on 24 March 2006, 2 months prior to separation, noted complaints of “posterior neck pain, which [radiated] into the posterior head region.”  The CI also reported “intermittent tingling in a glove distribution in both hands and also in a stocking distribution from the mid-calf down.”  Physical examination recorded ROM forward flexion “0-70 degrees” (normal is 45), extension “0-63 degrees” (normal is 45).  Painful motion was documented during ROM testing. The CI had normal motor strength, sensation, reflexes, and gait and his spinal contour was without deformity.  There was no muscle spasm or tenderness.

At the VA Compensation and Pension (C&P) examination on 23 June 2006, performed 1 month after separation, the CI reported neck pain that radiated to the “occipital area of the skull” causing “tension-type headaches.”  He also reported that he had “intermittent numbness in a glove-and-stocking distribution in bilateral hands and feet.”  The CI reported no incapacitating episodes in the last 12 months due to neck pain.  Physical examination showed ROM forward flexion and extension to 45 degrees, and a combined ROM of 320 degrees.  There was a functional loss of 5 degrees of flexion after repetitive motion due to pain.  His motor strength, sensation, reflexes, gait and spinal contour were all normal.  The examiner noted “no palpable spasming.” 

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the neck condition 0% under the 5237 code (cervical spine strain), citing full ROM with pain and likely application of AR 635-40.  The VA assigned a 10% rating using the analogous coding 5238-5242 (spinal stenosis and degenerative disc disease).  The Board first noted the absence of a compensable ROM in any of the treatment records prior to the C&P examination, and the measurements recorded at the NARSUM were not consistent with any treatment entry or the C&P examination.  However, the NARSUM examination documented painful motion. Therefore, the Board considered the application of VARSD 4.59, and also strongly considered the ROM documented at the C&P examination, and determined that a 10% rating, and no higher, was justified IAW VARSD 4.59 for painful motion, or for the combined ROM greater than 170 degrees but not greater than 335 degrees reported on the VA examination.  There was no muscle spasm or guarding severe enough to result in abnormal gait or spinal contour, thus the next higher 20% rating was not justified on this basis.  The Board considered whether a higher rating (§4.7) was achieved by using the alternate rating formula based on incapacitating episodes due to intervertebral disc syndrome.  Although the CI had intervertebral disc disease there were no 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.  The Board also considered if additional disability rating was justified for peripheral nerve impairment due to radiculopathy.  The presence of functional impairment with a direct impact on fitness is the key determinant in the Board’s decision to recommend any condition for rating as additionally unfitting.  The critical decision is whether or not there was a significant neurologic impairment which would impact military occupation specific activities.  There is no evidence in this case that a neurologic abnormality existed to any degree that could be described as 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 recommends a disability rating of 10% for the chronic neck pain condition, coded 5237.  

BOARD FINDINGS:  In the matter of the neck condition, the Board unanimously recommends a disability rating of 10%, coded 5237 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.  

The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Neck Pain	5237	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated, 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 XXXXXXXXXXXXXXXXXX AR20160011789 (PD201403982)

1.  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, accept the Board’s recommendation to modify the individual’s disability rating to 10% without re-characterization of the individual’s separation.  This decision is final.  

2.  I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum.   

3.  I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

 BY ORDER OF THE SECRETARY OF THE ARMY:

CF: 
(  ) DoD PDBR
(  ) DVA