RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-04077
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20021113

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Utilities Equipment Repairer, medically separated for “chronic neck pain…”, with a disability rating of 10%.

CI CONTENTION:  The CI requested consideration of all conditions.  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 - 20020730	VARD - 2002123	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Neck Pain …	5299-5295	10%	Degenerative Disc Disease, Cervical Spine	5293	10%	20021016	
Dysthymic Disorder	Not Unfitting	Dysthymic and Depressive Disorder	9433	30%	20021016	
Retropatellar Pain Syndrome (B) Knees	Not Unfitting	Retropatellar Pain Syndrome, Left Knee	5260	10%	20021016	
		Retropatellar Pain Syndrome, Right Knee	5260	10%	20021016	
Healing Partial Laceration of Extensor Tendon (R) Finger	Not Unfitting	Partial Laceration Of Extensor Tendon Of The Right Hand	5299-5255	NSC	20021016	
Rare Migraine Headaches	Not Unfitting	Migraine Headaches	8100	10%	20021016	
Intermittent Nummular Eczema	Not Unfitting	Nummular Eczema	7899-7806	NSC	20021016	
S/P Hysterectomy …	Not Unfitting	Hysterectomy	7617	50%	20021016	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  80%	

ANALYSIS SUMMARY:  The Board noted that this case was adjudicated by the PEB on 30 July 2002 while the old spine rules were in effect.  The CI was separated on 13 November 2002 when the interim spines rules were in effect.  These are used by the Board in its review and recommendation.  The current spine rules did not come into effect until 25 September 2003 and were not used by either the PEB or the VA in its initial adjudication.  

Chronic Neck Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s neck condition began in early 1998, without any specific injury.  The first record in evidence is dated 12 October 2000 and notes mid-back pain since a car accident at age 12.  In 2001, she reported a 2 year history of neck pain since overuse during air assault training.  She had full range of motion (ROM), but some pain with compression and radiation to the left.  An X-ray showed degenerative joint disease (DJD) at C5-6.  She was referred for chiropractic treatment and also was treated with medications.  These provided minimal relief.  An MRI done on 16 November 2001 showed degenerative disk disease (DDD) at several levels of the cervical spine.  There was also DJD affecting the C4, C5, and C6 nerve roots bilaterally without cord impingement.  The history noted that the CI had full ROM.  She was referred to orthopedics and nerve conduction studies of the left upper extremity (LUE) were ordered.  These were done in January 2002 and were normal.  In physical therapy (PT) on 17 January 2002, a mild decrease in flexion and left rotation was noted.  She was referred to the spine clinic and was seen on 20 February 2002.  She reported LUE weakness.  Chiropractic treatment had been intermittently helpful.  The examination, including ROM, was normal other than reduced sensation over the top of the left fifth finger.  She was thought to have myofascial pain syndrome and had been treated with injections in her neck and shoulder; however, these did not provide significant relief.  She was again noted to have normal ROM in PT on 19 March 2002.  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 an MEB.  The MEB forwarded DDD of the cervical spine for PEB adjudication.  During the MEB examination (recorded on DD Form 2807 Report of Medical History and  DD Form 2808 Report of Medical Examination) dated 20 March 2002, 8 months prior to separation, the CI reported chronic neck and upper back pain, which radiated down her left arm with aggravation.  The ROM was reduced as charted below.  Sensation was reduced for the LUE on the ulnar side.  Tenderness and spasm were present.  The motor examination was full.  Reflexes were diminished throughout the examination.  An orthopedic addendum for the MEB was dated 10 April 2002.  It noted tenderness of the neck without spasm.  The neurological examination was normal.  The ROM was near normal as charted below.  At a spine center follow up on 17 April 2002, the sensory loss of the LUE did not follow a peripheral nerve or nerve root pattern.  Myofascial pain or fibromyalgia was thought to be the most likely diagnosis.  The ROM remained normal.  The MEB NARSUM was dated 12 July 2002, 4 months prior to separation.  It noted that the CI could not walk over 2 miles without increased neck pain.  It referenced the DD 2808 for the physical findings.  At the 16 October 2002 VA Compensation and Pension (C&P) examination, performed 1 month before separation, the CI reported constant pain that radiated down her left arm and was associated with numbness of the left hand and leg.  The physical examination showed a normal gait.  Tenderness was present, but without deformity or spasm.  Any movement was painful.  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.  

Cervical ROM
(Degrees)	MEB ~4 Mo. Pre-Sep	Ortho ~4 Mo. Pre-Sep	VA C&P ~1 Mo. Pre-Sep	
Flexion (45 Normal)	35	45	10	
Combined (340)	265	---	200	
Comments	Tenderness and spasm.  Abnormal gait or contour not recorded	Tenderness without spasm.  Abnormal gait or contour not recorded	Painful motion Tenderness	
§4.71a Rating	10%	10%	20%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the neck condition 10% under an analogous 5295 code (lumbosacral strain), citing degenerative disc disease, early degenerative joint disease and spondylolysis of the cervical spine, without radiculopathy or chronic muscle spasm, and full functional (but painful) ROM.  The VA also assigned a 10% rating using the 5293 code (intervertebral disc syndrome) for MRI findings which show mild disc bulging with thecal sac impingement at C4-C6 and noted incapacitating episodes showing total duration of at least one week, but less than two weeks during the past 12 months.  The Board did not find evidence for incapacitation in the record and it is not clear what information was used by the VA rater for this determination.  The Board considered the findings.  The majority of neurological examinations were normal or showed a sensory loss which did not follow a nerve root or peripheral nerve pattern.  The evidence does not support the presence of an unfitting radiculopathy at separation.  The ROM was typically normal, or near normal, other than the VA examination which was an outlier from the other examinations.  This examination did not show spasm or another explanation for the reduction in motion.  It is also inconsistent with the level of pathology seen on testing.  The Board noted that the code 5290, limitation of motion of the cervical spine, was a better description of the neck condition but provided no rating advantage to the CI.  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 neck condition.  

Contended PEB Conditions: Dysthymic Disorder, Retropatellar Pain Syndrome (Bilateral) Knees, Right Index Finger, Migraines, Nummular Eczema, Hysterectomy, and Chronic Pelvic Pain.  The Board’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  None of the conditions were profiled or implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that any of the conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the chronic neck pain condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended dysthymic disorder, retropatellar pain syndrome (bilateral) knees, right index finger, migraines, nummular eczema and hysterectomy, and chronic pelvic pain conditions, the Board unanimously recommends no change from the PEB determination as not unfitting.  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, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB						

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

07 DEC 2016

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
AR20160018228 (PD201404077)

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