RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01299
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060109

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Signal Support Systems Specialist, medically separated for “chronic neck pain” with a disability rating of 10%.  

CI CONTENTION:  The CI requested a review of all conditions The CI’s complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The panel's scope of review is defined in DoDI 6040.44.  It is limited to review of disability ratings assigned 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 or non-compensable.  Any conditions outside the panel’s defined scope of review and any contention not requested in this application may remain eligible for future consideration by the panel for Correction of Military Records.  Furthermore, the panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The panel’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 panel 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 panel 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 - 20051206	VARD - None	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Neck Pain	5299-5242	10%	No VA Examination in Evidence	
Neuropathy Right C7 …	Not Unfitting		
Medial Collateral Ligament Strain	Not Unfitting		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  N/A	

ANALYSIS SUMMARY:  

Chronic Neck Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s neck condition began in June 1998 after a bad parachute landing fall.  He was able to perform his military duties despite his condition until June 2005 when he reinjured his neck while deployed and was evacuated from theater.  On 10 June 2005, it was noted by neurology that he could not move his neck on the (air evacuation) movement request form, but the same day in physical therapy, he was able to flex his neck to 3 cm from his chest (normal or near normal flexion).  Some restriction was present in the other planes, especially rotation at 20 degrees right and 25 degrees left (normal of 80 degrees).  Three days later in neurosurgery, he was noted to have radiation of pain with compression of the neck (Spurling maneuver), sensory loss to the right elbow, and weakness of the right biceps, triceps, and grip.  An MRI on 27 June 2005 showed degenerative disc disease (DDD) with a questionable protrusion of the disc at C4-5, but no nerve root impingement.  This was stable compared to a previous study dated 20 December 2000.  In neurology on 28 June 2005, he was noted to have reduced strength of the right triceps and biceps, with reduced reflexes, and decreased sensation in a C6/C7 distribution.  Muscle tone was normal.  Atrophy was not documented.  Flexion and extension were noted to be moderately limited from pain.  Electrodiagnostic studies on 13 July 2005, suggestive an acute, mild right C6/C7 radiculopathy.  He was evaluated by a second neurosurgeon on 18 July 2005 and found to have decreased range of motion (ROM) of the neck in all planes.  The reflexes were normal.  Sensation and strength were reduced for the right fingers (C5-T1), but otherwise normal.  Spasm was present and thought to account for the majority of his symptoms.  The Spurling maneuver was negative.  The next day, in physical therapy, he was noted to have tenderness of the cervical spine and active ROM reduced to 20 degrees in all planes with full passive ROM.  Motion was painful.  Sensation was reduced for the entire hand in no particular neurological pattern.  Motor function was abnormal without further specification.  The reflexes were specifically cited as normal.  One month later on 9 August 2005, the ROM was the same as were the sensory examination and reflexes.  The motor examination was noted to show weakness of all muscle groups of the right upper extremity (RUE) with hesitancy of effort.  A cervical epidural injection was not beneficial.  In neurology on 6 September 2005, he was noted to have decreased, but improved, motion with left and right rotation.  No comment was made on flexion, extension, or lateral bending implying that these were normal or near normal.  The motor function was normal other than the right finger flexors (C5-T1) and sensation was reduced in the right thumb (C5-6).  Reflexes and gait were normal.  It was noted that he had not responded to any of the normal treatments and a psychological evaluation was mentioned for consideration to evaluate for an underlying illness.  There was no surgical indication, and conservative treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “DDD with bulging disc at C6-7” for PEB adjudication.  

The NARSUM and MEB examination (recorded on the NARSUM and DD Forms 2807 and 2808) were accomplished by the same physician and dated 9 September 2005, 4 months prior to separation.  The CI reported marked constant pain in the neck and both arms to the hands bilaterally and that he was unable to carry on the normal activities of daily living.  On physical examination showed, the ROM was markedly decreased by pain with flexion of 15 degrees (normal 45) and a combined ROM of 70 degrees.  The CI had tenderness and muscle spasm, but there was no mention of guarding, abnormal gait or abnormal spinal contour.  The neurologic evaluation was normal.  There were no subsequent clinical records or VA examination in evidence.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the neck condition 10% under the analogous 5299-5242 code (degenerative arthritis of the spine), citing “ROM limited by pain, with localized tenderness.”  No VA rating was in evidence.  It considered the evidence.  The neurological examination was inconsistent between examinations and did not match the MRI.  The electrodiagnostic studies were suggestive, but not firmly diagnostic of a radiculopathy; it did not match the pathology on the MRI either.  Regardless, the neurological examination was normal on the NARSUM examination.  The evidence does not support the presence of an unfitting radiculopathy at separation.  The Board then considered the rating for the neck.  The ROM measured by the NARSUM examiner supports a 30% rating and is the most proximate to separation.  It is an outlier from earlier examinations which were near normal, 20 degrees (twice), and implied normal (rotation mentioned but flexion was not).  These support no more than a 20% rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 20% for the neck condition, coded 5299-5242.  

Contended PEB Conditions: Right C7 Neuropathy and Left Medial Collateral Ligament Strain.  The Board’s main charge is to assess the fairness of the PEB’s determination that right C7 neuropathy and left medial collateral ligament strain were not unfitting.  The right C7 neuropathy was addressed above.  The CI had been treated for the left knee several years prior to the MEB, but there were no clinical records in evidence for almost 3 years until in the MEB process.  An orthopedic evaluation released the CI without limitations.  The knee was profiled (but over written by hand and changed to a L1 profile) and implicated in the commander’s statement.  Both preceded the orthopedic evaluation.  The MEB, after the orthopedic evaluation, determined that the left knee condition was medically acceptable.  After due deliberation, the Board concluded that there was not a preponderance of evidence to overcome the PEB’s fitness findings for the CI’s right neuropathy or left knee condition.  Therefore the board finds insufficient cause to recommend a change in the PEB fitness determination for either the contended right C7 neuropathy or the left knee conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the neck condition, the Board unanimously recommends a disability rating of 20%, coded 5299-5242 IAW VASRD §4.71a.  In the matter of the contended right C7 neuropathy and the left knee 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	
Chronic Neck Pain	5299-5242	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150614, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170005986, XXXXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified to but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction. 

	A copy of this decision has also been provided to the Department of Veterans Affairs.

Sincerely,	
Enclosure