RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01005
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20070218

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Wheeled Vehicle Mechanic, medically separated for “chronic neck pain with mild general bulge at C4/5,” with a disability rating of 10%.

CI CONTENTION:  All unfitting conditions related to Lyme’s disease.  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 on 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 - 20061206	VARD - 20070926	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Neck Pain with Mild General Bulge at C4/5	5299-5237	10%	Degenerative Disc Disease, Cervical Spine, with Headaches	5243	10%	20071020	
Headaches to Neck Pain	Not Unfitting					
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:

Chronic Neck Pain with Mild [Disc] Bulge at C4-C5.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s neck condition began in August 2005 while working.  The CI denied any specific injury or trauma.  Magnetic resonance imaging (MRI) studies in January 2006 documented mild disc bulging of C4-C7 that resolved on a subsequent October 2006 MRI.  Electrophysiologic studies in August 2006 documented no evidence of right cervical or right lumbosacral radiculopathy, and no nerve entrapment.  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 “chronic neck pain, musculoskeletal in origin” for PEB adjudication.  

At the MEB NARSUM examination on 1 November 2006 (4 months prior to separation), the CI reported constant neck pain that increased throughout the day, headaches, and bilateral upper extremity tingling and numbness.  Physical examination showed spinal tenderness, muscle spasm and painful motion. Range of motion (ROM) was flexion to 20 degrees (normal 45), with a total combined range of motion (ROM) of 195 degrees (normal 340).  Strength, sensation, and reflexes were normal.  Gait and spinal contour were not addressed.  

At two separate VA Compensation and Pension (C&P) Spine/Joints and General examinations both dated 15 May 2007 (3 months after separation), the CI reported pain with occasional radiation into the upper extremities and head; and worse with bending and prolonged sitting.  She denied flare-ups and periods of incapacitation in the past year.  Physical examination revealed spinal tenderness with normal strength, sensation, and reflexes.  Repetitive ROM was flexion, extension, and bilateral lateral flexion were all 40 degrees (each normal 45) and bilateral rotation was 80 degrees (normal).

The Board directed attention to the rating recommendation based on the above evidence.  The PEB rated the neck condition 10%, analogous code 5299-5237 (cervical spine strain), citing tenderness and pain limited motion.  The VA rated the neck condition 10%, coded 5243 (intervertebral disc syndrome) based on the VA C&P examination 3 months after separation, citing limitation of motion.  Board members agreed that the 20 degrees flexion noted on the MEB NARSUM examination was not consistently reflective of the CI’s baseline level of disability.  The Board determined the totality of the STR and VA ROM evidence corroborated by normal MRI findings and the lack of muscle spasm or guarding resulting in an abnormal spinal contour, was more indicative of a 10% rating.  There was no evidence of intervertebral disc syndrome which resulted in incapacitating episodes requiring physician-prescribed bed rest to warrant consideration of rating under this alternate VASRD formula.  There was no associated radiculopathy for separate peripheral nerve rating.  While the CI may have experienced radiating pain from the neck condition, this is subsumed under the general spine rating criteria, which specifically states “with or without symptoms such as pain (whether or not it radiates).”  There was no objective evidence of a radiculopathy with functional impairments such as weakness with a direct impact on fitness that were separately functionally impairing for duty.  The Board therefore concluded 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 chronic neck pain condition.

Contended PEB Condition:  Headaches due to Chronic Neck Pain.  The Board’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The headaches were profiled 3 months after separation, and did not meet retention standards, however, they were not implicated in the commander’s statement, and there was no performance-based evidence from the record that headaches alone, significantly interfered with satisfactory duty performance at separation.  The headaches were adjudged as a component of her cervical condition and without her cervical condition, they would not be a factor.  After due deliberation, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition and so no additional disability rating is recommended.

BOARD FINDINGS:  In the matter of the chronic neck pain with mild [disc] bulge at C4-C5 condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended headache 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 20150606, 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

08 MAR 2017

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20170001065 (PD201501005)

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