RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02123
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20020407

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 “neck pain” with a disability rating of 20%.  

CI CONTENTION:  He contends “knees, low back, neck.”  The 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 - 20020116	VARD - 20080828	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Neck Pain with C6 Radiculopathy due to Degenerative Disc Disease and Osteophytes	8710	20%	Degenerative Disc Disease of Cervical Spine with Right Sided Radiculopathy	5243	0%	STR	
Chronic C8 Radiculopathy	Not Unfitting 
	No VA Placement	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Chronic Neck Pain.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s neck pain condition began in 1993 during basic underwater demolitions SEAL training with no known injury, the CI just woke up with it one morning.  Radiographic study (MRI) showed evidence of cervical disk bulge without herniation.  The CI’s pain responded to physical therapy and he was able to manage the discomfort without medication; however, the numbness in his right thumb and index finger never resolved.  Surgery was not recommended at that time.  In 1998, after entering the Army, the CI reinjured his neck.  Plain film X-Rays showed mild disk space narrowing at C5-C6 with osteophytes.  The CI initially responded to physical therapy but the neck and upper right extremity discomfort progressively become more severe and duty restrictions were applied.  By September 2001 he had undergone multiple rounds of physical therapy, home traction and medications.  The neurosurgeon felt there was no surgical indication.  

During the 20 July 2001 MEB examination (recorded on SF Form 93 and SF Form 88), 9 months prior to separation, the CI reported constant posterior neck pain with right upper extremity numbness extending down to his hand involving the right thumb and index finger.  Physical examination showed flexion “chin to chest” (normal), extension to 20 degrees (normal 45), rotation to the right and left 30 degrees each (normal 80), 5/5 strength throughout, deep tendon reflexes 1+/4 right and left biceps and triceps.  The examiner noted a decrease in vibratory sense at the base of the thumb of the right hand compared with the left.  At the 6 September 2001 Neurosurgical examination, 7 months prior to separation, the CI reported continued right arm numbness with right neck pain.  Physical examination showed full extension, increased pain with axial load, negative Spurling’s test (test for nerve root impingement) and muscle strength was recorded as 5/5 upper and lower extremities.  

The 7 December 2001 MEB NARSUM examination, 4 months prior to separation, noted complaints of chronic neck discomfort with frequent exacerbations of the neck and right upper extremity discomfort aggravated by strenuous activity, running, and lifting greater than 20 pounds.  Pain medications, include Lodine (non-steroidal anti-inflammatory) twice daily, Neurontin (neuropathic pain medication, non-narcotic) one to two daily and Benadryl at bedtime as needed for sleep.  Physical examination showed pain on axial loading of the neck, negative Spurling’s sign, upper extremity motor examination displayed 5/5 strength in all muscle groups.  Sensation was intact except for a subjective variable numbness to the right thumb to touch.  There was full range of motion (ROM) with pain to neck flexion; however, all other motions were normal without pain.  There was no VA Compensation and Pension (C&P) examination in evidence proximate to separation.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the neck pain condition 20%, coded 8710 (Neuralgia), citing radicular pain and numbness of the thumb.  The VA rated the neck pain condition 0% coded 5243 (intervertebral disc syndrome), based on the STR citing absence of VA examination.  The panel agreed that no higher than a 20% was justified based on constant posterior neck pain with right upper extremity numbness extending down to his hand involving the right thumb and index finger reported on all exams.  There was no documentation of intervertebral disc syndrome with incapacitating episodes which would provide for a higher rating under that formula.  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 neck condition.  

Contended PEB Conditions: Chronic C8 Radiculopathy.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The contended condition was not profiled or implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  The presence of functional impairment with a direct impact on fitness is the key determinant in the panel’s decision to recommend any condition for rating as additionally unfitting.  The panel therefore concluded that an additional disability rating was not justified on this basis.  After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the contended chronic C8 radiculopathy condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the neck condition and IAW VASRD §4.124a the panel unanimously recommends no change in the PEB adjudication.  There are no other conditions within the panel’s scope of review for consideration.  The panel, 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 20150801, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170010112, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	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.

Sincerely,