RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00719
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050509

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty Reservist O2, Military Intelligence Officer, medically separated for “chronic radiating neck pain,” with a disability rating of 20%.

CI CONTENTION:  The CI contends that his hypertension and plantar fasciitis should be service connected.  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 - 20050401	VARD – 20051004	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Radiating Neck Pain	5241	20%	C5-6 DDD S/P Fusion	5243	20%	20050705	
Pes Planus …	Not Unfitting	Pes Planus with Plantar Fasciitis	5276	0%	20050705	
Labile Blood Pressure	Not Unfitting	Hypertension	7101	0%	20050705	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Chronic Radiating Neck Pain.  

According to service treatment records (STR) and the MEB narrative summary (NARSUM), the CI was seen in 2004 with a 3-4 year history of neck pain without specific antecedent trauma.  Initial X-rays were negative and he was treated in both physical therapy (PT) and with chiropractic therapy.  On 23 August 2004, an MRI showed degenerative disc disease (DDD) at C5-6 with herniation and a tear.  CI underwent cervical spine surgery, C5-6 anterior cervical discectomy and anterior interbody fusion and anterior cervical plating, on 15 November 2004.  He was identified for an MEB due to the fusion.  Following surgery, the CI was cleared for rehabilitation in PT on 6 January 2005.  The MEB forwarded “cervical spine” for PEB adjudication.  In orthopedics on 8 February 2005, the CI was noted to have minimal limitations in the range of motion (ROM) due to pain and a normal neurological examination.  Formal ROM measurements were obtained on 1 March 2005, 3 ½ months after surgery and 6 weeks after clearance to begin rehabilitation.  These were restricted from pain as charted below.  The MEB NARSUM examination on 18 March 2005, 2 months prior to separation, noted complaints of constant neck pain aggravated by activity and extremes of motion.  The physical examination on 1 March 2005 showed tenderness, no palpable spasm or visible deformity.  Electromyography (EMG) studies were negative for radiculopathy.  At the 5 July 2005 VA Compensation and Pension (C&P) examination, performed 2 months after separation, the CI reported constant pain.  The CI reported that he had missed 20 days of work out of the last year (this is expected from the hospitalization and subsequent convalescent leave).  The physical examination showed normal gait.  The CI sat and stood without difficulty, but changed his torso to change direction of his vision.  The ROM showed a forward flexion limited to 25 degrees and a combined ROM of 110 degrees; this did not change with repetition.  The examiner speculated that there would be an additional loss of 5 degrees of forward flexion from increased pain and muscle spasm.  Spasm was not documented on the examination.  This examination was 8 months post-surgery and 6 months after the beginning of rehabilitation.  The range of motion (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 ~2 Mos. Pre-Sep	VA ~2 Mos. Post-Sep	
Flexion (45 Normal)	10	20	
Combined (340)	170	100	
Comments	Painful motion.  3 ½ months after surgery.  6 weeks of rehabilitation	5 degree loss with repetition	
§4.71a Rating	30%	20%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the neck condition 20% under 5241 code (spinal fusion), citing limited motion and tenderness.  The VA also assigned a 20% rating using 5243 code (intervertebral disc syndrome) for limitation of forward flexion.  The Board considered the MEB and VA C&P examinations.  Both are proximate to separation.  The latter agrees more closely with the orthopedic examination.  In addition, it is more remote from surgery and also more remote from the initiation of rehabilitation following surgery.  It is therefore assigned a higher probative value for rating purposes.  The Board agreed that a 20% rating, but no higher, was justified for limitation of flexion (greater than 15 degrees but not greater than 30 degrees) and combined ROM (not greater than 170 degrees) and muscle spasm or guarding severe enough to result in an abnormal gait or spinal contour, reported on the MEB, NARSUM, VA, examinations.  The Board concluded there was no evidence to support a rating higher than the rating adjudicated by the PEB.  There was no evidence of an associated unfitting radiculopathy for consideration of a separate peripheral nerve rating.  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 chronic radiating neck pain condition.

Contended PEB Conditions:  Pes Planus with intermittent Plantar Fasciitis and Labile Blood Pressure.  The Board’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  Neither of the conditions was 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 radiating neck pain condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended pes planus with intermittent plantar fasciitis and labile blood pressure 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, 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 20150605, w/attachments
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, AR20170000066 (PD201500719)

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