RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00816
BRANCH OF SERVICE:  Marine Corps 	

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a Reserve E4, Marine Aviation Maintenance Administration Clerk, medically separated for “cervical ligamentous strain,” with a disability rating of 10%.

CI CONTENTION:  The CI made no specific contention.  The 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 - 20020916	VARD - 20040206	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Cervical Ligamentous Strain	5299-5295	10%	Cervical Ligamentous Strain	5293	0%	20040102	
Post-traumatic Headaches	Cat II	Post-traumatic Headaches	8045	10%	20040102	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Cervical Ligamentous Strain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s neck strain condition began in December 2000 after a large nutcracker statue fell on her head and neck.  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 “posttraumatic headaches” for PEB adjudication.  At the time of the primary care clinic appointment on 4 August 2001, the CI complained of headaches lasting for about 5-6 weeks.  On examination the neck showed full range of motion.  Additionally, at the time of a neurology appointment on 14 May 2002, examination showed full range of motion for the neck.  During the MEB examination on 1 June 2002, approximately 6 months prior to separation, physical examination showed mild tenderness to palpation C-spine.  At the MEB NARSUM examination on 15 May 2002 the CI had complaints of 1 to 3 headaches each week that she was able to eliminate with medication.  Physical examination was completely normal including neurologic examination.  The MEB NARSUM addendum, noted reports of daily headaches with associated neck and shoulder pain.  The physical examination showed muscle spasms in the trapezius and temporalis muscles.  Botox was administered for muscles spasms.  The examiner stated, “I believe that her pain stems primarily from muscle strain as well as ligamentous strain” and that the CI’s headaches are “more likely due to chronic cervical pain.”  At the 2 January 2004 VA Compensation and Pension (C&P) examination, performed approximately 12 months after separation, the CI reported headaches that start from around the eyes and radiate to the back of the head due to the spine condition, she has suffered from pain located at the left vertebral area.  She also claimed that she was unable to vacuum, drive a car, climb stairs, walk, shop, perform gardening activities and push a lawn mower due to headache exacerbation.  She denied any neck pain, reduced range of motion and muscle spasm.  The pain was localized, occurred 5 times per week, and lasted 12-24 hours.  The pain was elicited by physical activity and stress and relieved by medication, Advil or Fiorinal.  The CI stated that her condition did not cause incapacitation, but resulted in 10 days per year of time lost from work.  Physical examination showed no evidence of radiating pain on movement, muscle spasm, or tenderness.  Range of motion was full and was not additionally limited by pain, fatigue, weakness, lack of endurance or incoordination.  There was no ankylosis or signs of intervertebral disc syndrome present.  Peripheral nerve and neurological examinations were normal (normal motor function, sensory, and l reflexes).  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the neck pain condition 10% under the analogous 5295 code (lumbosacral strain).  The PEB listed the post-traumatic headaches condition as a related diagnosis (Category II) which contributed to the disability in this case.  The Board agreed that the post-traumatic headache was a diagnosis related to the cervical ligamentous strain (neck pain) and was not a separate condition which could be separately rated IAW §4.14 (avoidance of pyramiding; more than one rating based on the same impairment is prohibited).  The VA assigned a 0% rating using the 5293 code (intervertebral disc syndrome), citing a non-compensable evaluation.  The VA did assign a 10% rating using the 8045 code (residuals of traumatic brain injury) for post-traumatic headaches suggestive of post-concussion syndrome.  Although there was insufficient limitation of motion to support a minimum rating, the Board agreed a 10% rating was justified for the presence of characteristic pain on motion.  There was no muscle spasm on extreme forward bending, loss of lateral 20 spine motion, unilateral, in standing position, 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 5293, or evidence of ratable peripheral nerve impairment which would provide for additional rating.  The Board also consider rating under 8045 residuals of traumatic brain injury (TBI); however neck pain with headaches did not rise above a 10% 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 cervical ligamentous strain condition.

BOARD FINDINGS:  In the matter of the cervical ligamentous strain condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended posttraumatic headaches condition, 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 20150604, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW
               BOARDS 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS
 
Ref:   (a) DoDI 6040.44
       (b) CORB ltr dtd 15 Nov 16

      In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for the reasons provided in their forwarding memorandums, approve the recommendations of the PDBR that the following individual’s records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy’s Physical Evaluation Board:

		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USMC

						  XXXXXXXXXXXXXXXXXXX
	     				  Assistant General Counsel
						  (Manpower & Reserve Affairs)