RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX		CASE:  PD-2015-00097
BRANCH OF SERVICE:  Army  		DATE OF SEPARATION:  20041014

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4, Signal Intelligence Analyst, medically separated for “chronic neck pain" with a disability rating of 10%.  

CI CONTENTION:  “Please consider all conditions.”  His 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 - Dated 20040519	VARD - 20051018	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Neck Pain	5299-5237	10%	Cervical Spine Injury 	5237	NSC	No Show	
RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NSC	

ANALYSIS SUMMARY:  

Chronic Neck Pain.  According to service treatment records and the MEB narrative summary (NARSUM), the CI’s neck pain condition began in November 2002 with no history of antecedent trauma.  Magnetic resonance imaging of the cervical spine on 10 January 2003 showed small midline disc herniation’s at the C5-6 and C6-7 levels.  Neck symptoms flared after an assault in February 2004, and was associated with numbness of the upper extremities.  Electrodiagnostic testing in June 2004 found denervation consistent with a right C-6 radiculopathy.  There was no surgical indication, and conservative treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “chronic severe neck pain” for PEB adjudication.

At a neurosurgery consult on 30 January 2004 (8 months prior to separation), the CI reported he had to quit running and decreased his activity due to neck pain, for which he was taking narcotic medication.  The neurologic examination was noted as normal, although range of motion (ROM) was decreased.  Cervical ROM measurements performed by physical therapy (PT) on 1 April 2004 (6 months prior to separation) showed flexion of 35 degrees (normal 45 degrees) and a combined ROM of 190 degrees (normal 340).  All measurements included 3 repetitions.  

The MEB NARSUM examination on 6 April 2004, 6 months prior to separation, noted complaints of constant neck pain.  Pain was described as sharp, aching, and sometimes feeling like a shocking sensation.  Aggravating factors included sleeping, physical activity or movement.  He could not run without pain, but could walk 1 mile.  The CI denied impaired use of his arms or hands.  Physical examination showed restriction of motion in all planes limited by pain, but there was no tenderness.  No sensory or motor deficits were evident.  Gait was recorded as normal.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the condition 10%, analogously coded 5299-5237 (cervical strain), citing a restricted range of motion due to pain.  The VA did not service-connect the CI’s cervical condition; and the service-connection denial continued through the last VA rating decision dated 1 May 2015.  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 in the NARSUM.  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 (IVDS).  Although the CI had intervertebral disc disease there were no incapacitating episodes requiring physician-prescribed bed rest to warrant consideration of rating under the alternate VASRD formula (for IVDS).  The Board finally considered if additional disability rating was justified for peripheral nerve impairment due to radiculopathy.  The CI reported upper extremity numbness, and subsequent electrodiagnostic testing findings were consistent with right C6 radiculopathy.  However, 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.  While the CI may have experienced pain from the neck condition that radiated to the upper extremities, this is subsumed under the general spine rating criteria, which specifically states “with or without symptoms such as pain (whether or not it radiates).” Therefore the critical decision is whether or not there was a significant motor weakness which would impact military occupation specific activities.  Available neurologic examinations however noted normal muscle strength.  There was no evidence in this case that motor weakness existed to any degree that could be described as functionally impairing.  The Board therefore concludes 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 cervical spine condition.  

BOARD FINDINGS:  In the matter of the cervical spine 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 20140711, 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

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20160018851 (PD201500097)

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