RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-04110
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070324

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an National Guard E6, Cannon Crew Chief, medically separated for “chronic radiating neck pain…” with a  disability rating of 0%.

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 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 - 20070207	VARD - 20080912	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Radiating Neck Pain…	5299-5237	0%	Cervical Degenerative Disc Disease 	5242	20%	20071024	
Right Shoulder Pain	Not Unfitting	Labral Tear with History of Surgical Repair to Rotator Cuff and Biceps Tendon, Right Shoulder	5201	10%	20071024	
Migraine Headaches	Not Unfitting	Transformed and Episodic Migraines	8100	10%	20071024	
OSA	Not Unfitting 	Sleep Apnea
	6847	NSC	20071024	
GERD	Not Unfitting 	No VA Placement 	
Pancreatic Pseudocyst	Not Unfitting 	No VA Placement	
Anxiety Disorder	Not Unfitting 	No VA Placement	
Recurrent Prostatitis	Not Unfitting 	No VA Placement	
Bilateral Tinnitus	Not Unfitting 	Tinnitus	6260	10%	20071024	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:  

Neck Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s neck condition gradually began between August 2004 and April 2005 with no injury recalled.  The pain increased while deployed and wearing Kevlar helmet and radiation into the right upper extremity became severe in August 2005.  Magnetic resonance imaging (MRI) studies in September 2005 showed herniated discs at C3-4 and C5-C6.  At the time of the neurosurgery appointment on 4 October 2005, the examiner did not feel surgery was indicated.  Electrodiagnostic studies, 27 June 2006, were negative for radiculopathy (nerve root irritation or injury).  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 “degenerative disk disease at C5-6” for PEB adjudication.  Cervical spine range of motion (ROM) measurements performed by physical therapy (PT) on 26 July 2006 (8 months before separation) were flexion of 40 (normal 45) and combined of 275 (normal 340) degrees after repetition.  The MEB NARSUM was derived from a telephone interview on 24 October 2006 (5 months prior to separation) and noted continued complaints of neck pain interfering with the CI’s his ability to perform MOS duties.  The CI reported right-sided neck pain, rated 3/10 that increased to 6/10 as the day progressed.  He complained of associated radiation to the right scapula with paresthesias (abnormal sensation, tingling, burning, prickling) occasionally to the right 4th and 5th fingers.  For the physical examination, the NARSUM physician cited an examination performed by a physician assistant on 19 July 2006.  The neck examination revealed no deformity or muscle spasms.  Cervical axial compression produced pain in the right neck, right posterior shoulder, and into the right upper arm.  Cervical spine ROM measurements were flexion of 40 (normal 45) and combined of 275 (normal 340) degrees after repetition, limited by pain.  Strength, sensation, and deep tendon reflexes (DTRs) were normal and pathologic reflexes were absent.  At the VA Compensation and Pension (C&P) examinations in October 2007, performed 7 months after separation, the CI reported neck pain on a daily basis with no radicular symptoms.  The CI reported 2-3 days of prescribed bedrest in the last year.  Physical examination documented a normal gait and the neck showed moderate tenderness.  Cervical spine ROM measurements were flexion of 20 (normal 45) degrees with painful motion which increased on repetitive movement, but without additional loss in motion.  Sensation was intact, however diminished in the right upper extremity.  Strength and DTRs were normal and pathologic reflexes were absent.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 0% rating under an analogous 5237 code (cervical spine strain), citing no mechanical loss of motion.  The VA assigned a 20% rating under the 5242 code (degenerative arthritis of the spine) based on the VA C&P examination 7 months after separation, citing forward flexion of the cervical spine greater than 15 degrees but not greater than 30 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 combined ROM (greater than 170 degrees but not greater than 335 degrees) reported on the NARSUM 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 on this basis.  There was no documentation of intervertebral disc syndrome with incapacitating episodes which would provide for a higher rating under that formula, or evidence of ratable peripheral nerve impairment which would provide for additional rating.  The ROM values reported by the VA examiner (7 months after separation) were significantly worse than those reported by the MEB examiner.  There was no record of recurrent injury or other development in explanation of the more marked impairment reflected by the VA measurements.  While ROM limitations may have progressed over time, there was no evidence in the record from which to conclude that the severity at separation approached that portrayed by the VA measurements.  Also, the VA ROM measurements were incomplete.  Therefore, based on all evidence and associated conclusions just elaborated, Board consensus was that preponderant probative value should be assigned to the MEB physical therapy ROM examination.  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 cervical spine condition, coded 5242 (degenerative arthritis of the spine).  

Contended PEB Conditions.  Right shoulder pain, migraine headaches, mild obstructive sleep apnea, gastroesophageal reflux disease, pancreatic pseudocyst, anxiety disorder NOS, recurrent prostatitis, and subjective episodic bilateral tinnitus.  The migraine headaches, mild obstructive sleep apnea, gastroesophageal reflux disease, pancreatic pseudocyst, anxiety disorder NOS, recurrent prostatitis, and subjective episodic bilateral tinnitus conditions were not profiled or implicated in the commander’s statement and were not judged to fail retention standards.  The right shoulder condition was listed on the profile, but the NARSUM and MEB both indicated this condition met retention standards.  Although the CI underwent surgical intervention in February 2006, the CI had significant improvement.  Three months after surgery his ROM was noted to be full at the orthopedic surgery follow-up appointment.  At the NARSUM examination, the CI stated he would be able to perform his MOS if his shoulder was his only medical problem.  There was no performance based evidence from the record that these conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, and in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the right shoulder pain, migraine headaches, mild obstructive sleep apnea, gastroesophageal reflux disease, pancreatic pseudocyst, anxiety disorder NOS, recurrent prostatitis, and subjective episodic bilateral tinnitus contended conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the cervical spine condition, the Board unanimously recommends a disability rating of 10%, coded 5242 IAW VASRD §4.71a.  In the matter of the contended conditions, the Board unanimously recommends no change from the PEB determinations as not unfitting.  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	
Neck Pain	5242	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

SAMR-RB										

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

02 DEC 2016

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
, AR20160017817 (PD201404110)

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