RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01609
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060828

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Health Care Specialist, medically separated for “chronic cervicalgia…” and “headache,” rated 10% and 0%, respectively, with a combined disability rating of 10%.

CI CONTENTION:  “Review 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 Board 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 determination 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(s) 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 - 20060810	VARD - 20070806	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Cervicalgia…	5237	10%	Cervical Spine Degenerative Disc Disease	5242	10%	20060921	
Headache…	8100	0%	Migraine Headaches	8100	10%	20060921	
Anxiety Disorder	Not Unfitting	Post-Traumatic Stress Disorder	9411	50%	20060921	
Hyperlipidemia	Not Unfitting	No VA Placement	
Irritable Bowel Syndrome	Not Unfitting	Irritable Bowel Syndrome	7319	30%	20060921	
Seasonal Nasal Allergies	Not Unfitting	Allergies	6522	NSC	20060921	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:  

Chronic Cervicalgia.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s neck condition began in 1995 after a parachute malfunction caused a hard landing.  Radiographic studies from May and June 2005 showed degenerative changes and herniated disc at C4-C5.  Electrodiagnostic studies on 24 October 2005, were negative for radiculopathy.  There was no surgical indication, and conservative treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “chronic neck pain” for PEB adjudication.  At the time of the MEB consult on 22 May 2006 (4 months prior to separation), the CI reported complaints of pain, which was at the midline from the C4 to the mid scapula level.  This was worse when he was sitting still, and with any outdoor activity.  He had pain with coughing or sneezing, down both arms.  He had tingling and numbness in the arms in a stocking-glove distribution.  There was no weakness to his arms.  On examination the doctor recorded that the CI “lacked perhaps 5 degrees of flexion, but extension, side bends, and rotation are symmetrical and full.”  There was no asymmetry of his shoulder musculature.  Biceps, brachioradialis and triceps jerks were symmetrical.  Two point sensation was normal.  Sensation to the musculocutaneous, axillary nerve, and radial nerve distributions were normal.  

The MEB NARSUM examination on 11 July 2006 (2 months prior to separation) noted complaints of pain at the base of the CI’s neck posteriorly which he described as "sharp."  His pain was "constant" with an average pain level of 5 on a scale of 1-10.  The CI complained the pain radiated down into both arms which occurred twice per month.  There was no associated numbness or tingling with these episodes.  His neck pain increased with Valsalva maneuvers.  There was no ataxia.  His neck pain was aggravated by running (he could run at his own pace and distance for a maximum of 1/2 mile), lifting weight (maximum 20 pounds), sit-ups and push-ups.  His neck pain was improved with the use of medications (Mobic and Robaxin).  Cervical spine range of motion (ROM) measurements were flexion 40 degrees (normal 45) and combined cervical ROM of 270 degrees (normal 340).  

At the 21 September 2006 VA Compensation and Pension (C&P) evaluation, performed 1 month after separation, the CI reported neck strain, stiffness and radiation to shoulders.  Pain was elicited by lifting, bending or movement of neck.  The pain only radiated as far as his arms and was relieved by Ibuprofen and Mobic.  The CI reported missing 10 days of work due to incapacitation.  Cervical spine ROM measurements were flexion 45 degrees (normal 45) and combined cervical ROM of 270 degrees (normal 340).  ROM was limited due to pain, but not by fatigue, weakness, incoordination, instability or lack of endurance after repetitive use.  Neurological testing revealed full motor strength in all muscles including grip strength, sensation was intact and deep tendon reflexes were 2+ bilaterally in all extremities.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic cervicalgia condition 10% under the 5237 code (cervical spine strain), citing full ROM, no spasm or altered cervical curvature.  The VA also assigned a 10% rating using the 5242 code (degenerative arthritis of the spine) for limitation of motion due to pain.  The panel agreed that a 10% rating, but no higher, was justified for limitation of flexion (greater than 30 degrees but not greater than 40 degrees) reported on the NARSUM examination and combined ROM (greater than 170 degrees but not greater than 335 degrees) reported on the NARSUM and VA examinations.  There was no muscle spasm or guarding severe enough to result in an abnormal gait or spinal contour, thus the next higher 20% rating was not justified on this basis.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the cervicalgia condition.  

Migraine Headaches.  According to STR and the MEB NARSUM, the CI had a history of migraine headaches since December 2005.  Despite treatment, the migraine headache condition could not be adequately treated to meet the physical requirements of the CI’s military specialty and the CI was referred for an MEB.  The MEB forwarded “recurrent complicated migraines” for PEB adjudication.  Review of the STR revealed one encounter of care for headache during the several months before separation.  It was for acute headache.  At the MEB NARSUM examination the CI reported that on four occasions, he had headaches occur at work and that he was sent home and driven home by another soldier a couple of times.  He denied any visits to the Emergency Room.  The NARSUM physical examination noted the CI’s last headache “occurred one month ago” and that it lasted 30 minutes.  The examiner also noted “over the last 6 months, he has had five episodes, each time he will sit down until they resolve.  The CI reported that the headache part is "really not that bad.”  Average pain level was "2 to 3."  When he got the headaches they came with blurred vision and difficulty with articulation of speech, and that those two symptoms made it difficult for him.  The STR fell silent with regard to care for headaches between the NARSUM and the time of separation, 2 months later.  The commander’s statement did not report frequency of missed work due to prostrating attacks.  At the 21 September 2006 C&P examination the CI reported headaches causing an aura, tingling of hand and face, blurred vision and irregular or difficult speech.  The condition was associated with nausea and photophobia, but not with vomiting.  The headaches caused loss from work.  The headaches occurred every month, but have responded to Inderal and only one headache in the last 2 months was reported.  Neurological examination reported cranial nerves 3-12 as grossly intact.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the headache condition 0% (code 8100 migraine) citing episodes occur approximately one time per month lasting 30 to 45 minutes and that they did “not meet the criteria for prostrating headaches.”  The VA rated the headache condition 10% (code 8100) citing the conditions as completely prostrating which cause loss from work, and occurring every month, but responding to Inderal and only one headache in the last 2 months reported.  Rating guidance under diagnostic code 8100 is based on the frequency of “prostrating attacks” over the “last several months.”  The VASRD does not further define prostrating attacks however commonly accepted definitions include “utter physical exhaustion or helplessness” (Webster's New World Dictionary of American English), “complete physical or mental exhaustion” or “extreme exhaustion or powerlessness” (Dorland's Illustrated Medical Dictionary).  The panel considered the results of the NARSUM examinations along with the evidence of the treatment records to accurately assess the overall disability picture (§4.2) at the time of separation.  After reviewing the evidence of the treatment records, the panel unanimously agreed that the CI’s headache condition most closely matched the criteria for a 10% rating under VASRD code 8100 at the time of separation.  There was no clear evidence of characteristic prostrating attacks occurring on an average once a month over last several months to justify a 30% rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a separation rating of 10% for the headache condition coded 8100.  

Contended PEB Conditions:  Anxiety Disorder, Hyperlipidemia, Irritable Bowel Syndrome and Seasonal Nasal Allergies.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  None of the conditions were 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 panel 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 cervicalgia condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the headache condition, the panel unanimously recommends a disability rating of 10%, coded 8100 IAW VASRD §4.124a.  In the matter of the contended anxiety disorder, hyperlipidemia, irritable bowel syndrome and seasonal nasal allergies conditions, the panel unanimously recommends no change from the PEB determinations as not unfitting.  There were no other conditions within the panel’s scope of review for consideration.  

The panel 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 Cervicalgia	5237	10%	
Headache	8100	10%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150617, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170008560, XXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified 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