RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02245
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20030728

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

CI CONTENTION:  “Review all conditions.”  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 - 20030604	VARD - 20031029	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Neck Pain associated with Headaches Status Post Motor Vehicle Accident	5290	10%	Degenerative Disc Disease ·with Herniated Nucleus Pulposus C5-6, Cervical Spine	5242	10%	20030723	
History of Lumbar Herniated Nucleus Pulposus	5295	Cat II	Degenerative Disc Disease, Lumbar Spine with Herniated Nucleus Pulposus L4-5	5242	10%		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS: 20%	

ANALYSIS SUMMARY:  

Chronic Neck Pain associated with Headaches Status Post Motor Vehicle Accident (MVA).  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s neck pain began in 1997 after an MVA following a “whiplash” type injury.  She was diagnosed and treated for chronic neck pain and headaches (HA) due to myofascial and ligamentous pain of the cervical spine and musculature.  
Magnetic resonance imaging (MRI) of the cervical spine on 2 December 2002 was normal.  Serial examinations in November 2002 noted “decreased” range of motion (ROM), “limited” motion, and full ROM except for slight limited anterior flexion due to discomfort.  The 17 December 2002 neurosurgery consult, 7 months before separation, noted a 4 year history of neck pain and headaches following the MVA noted above.  The CI was treated with physical therapy and neck injections which helped the HAs, but she reported pain in the back of the neck.  The neurosurgeon noted the CI had recently improved after neck injections and there was no longer radiation of the pain.  He indicated there was a small disc herniation at C5-C6 on the MRI without spinal stenosis or nerve impingement and confirmed there was no surgical indication.  Notes in the STR in January 2003 indicate the Ci was referred for an MEB for the neck pain condition.  The 15 January 2003 pain medicine evaluation, 6 months before separation, noted that the CI had flexion of the neck of approximately 60 degrees (normal 45) and extension of 30 degrees (normal 20) with pain, with no radicular symptoms with movement.  A 4 February 2003 referral for osteopathic evaluation noted the CI had “great” cervical motion and questioned hypermobility.  The osteopathic examination, 6 months before separation, noted “limited” flexion and right rotation.  A 17 March 2003 primary care note, 4 months before separation, recommended the CI be placed on “sick-in-quarters” (SIQ) until the medical board was completed.  During that time the restrictions included avoidance of aerobic activities, no formations, no command gatherings, no cycle ergometry.  The CI was permitted to participate in activities of daily living such as going to the store, medical and school visits, and other necessary activities within reason.  

The 15 May 2003 MEB NARSUM examination, 2 months prior to separation, noted complaints of worsening neck pain and HAs, with episodic muscle spasm, without radiating pain into the arms or hands.  Physical examination of the neck noted the CI was wearing a soft cervical collar.  There was “very limited” ROM in all directions with the posterior cervical area being “tight and tender” from the base of the skull to the upper trapezius muscle bilaterally.  Neurologic testing revealed normal strength and sensation in the arms and hands.  The MEB NARSUM examiner noted that the CI’s neck and myofascial pain seemed to be chronic and intermittently severe and required frequent visits to physical medicine/pain clinics for care.  

At the 23 July 2003 VA Compensation and Pension (C&P) evaluation, 5 days before separation, the CI reported “constant pain” in the cervical and a chronic right trapezius muscle spasm requiring narcotic pain medication.  She reported the pain radiated up the back of the head to the top of the head.  There was a radicular component down the right arm at times and pain increased with running.  She was unable to do any type of quick movements with her head or lift over 10 pounds.  Physical examination showed normal posture and gait.  There were no abnormal spinal contours.  There was tenderness to palpation over the cervical neck and right trapezius muscle spasms.  Neck ROM was “full” with normal upper extremity strength, sensation and reflexes.  A repeat cervical spine MRI in February 2003 was reported as negative.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the neck pain 0%, coded 5290 (cervical spine, limitation of motion) citing DoD and VASRD guidelines.  The VA rated the neck pain 10% with the current VASRD 5242 (Degenerative arthritis of the spine) code, based on the VA C&P examination 5 days before separation, citing painful but “full” ROM. 

The panel must provide a rating recommendation based upon the VASRD rules for rating the spine in effect on the date of separation.  Applicable diagnostic codes include: 5290 (limitation of cervical spine motion); 5293 (intervertebral disc syndrome; based on incapacitating episodes); and analogous to 5295 (Lumbosacral strain).  The MEB NARSUM referred to the ROM as “very limited”, but there was more clearly stated evidence in the STR and at the VA examination, before and after the MEB NARSUM examination, to support a 10% rating coded 5290 for “slight” limitation of cervical motion.  
The cervical MRI showed evidence of degenerative disc disease and the CI reported radiating pain and numbness of the right upper extremity.  However, there was no evidence of objective chronic neurologic manifestations to provide a higher rating under 5293 (intervertebral disc syndrome).  There was also no evidence of incapacitating episodes due to the neck condition defined as physician prescribed bed rest for a higher rating than 10% under 5293.  Although the CI was placed SIQ from March 2003 forward, her recommended limitations exceeded bedrest.  The panel also considered if the neck could be rated higher than 10% if coded analogous to lumbosacral strain (5292), but there was no evidence of loss of cervical motion associated with the muscle spasm noted on the VA C&P examination proximate to separation.  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 pain.  

Contended PEB Condition.  The panel’s main charge is to assess the fairness of the PEB’s determination that the Category II “history of lumbar herniated nucleus pulposus” condition was not unfitting.  According to the STR and MEB NARSUM, the CI had a long history of chronic low back pain (greater than 10 years) and a herniated disc had been noted on an MRI in the 1990’s.  In November 2002 she presented with complaint of increased lower extremity numbness in a radicular distribution (L4-5, L5-S1).  Magnetic resonance imaging in December 2002 showed degenerative disc disease and a neurosurgical consult did not recommend surgery at the time.  Although the CI was being treated for her LBP, in early January 2003 she was profiled for the neck condition and a MEB was initiated for the neck condition.  The commander’s statement dated 23 January 2003 referenced “a myriad of physical ailments,” which required absence from work for significant periods of time as impairing the CI’s duty performance and also referred to “chronic pain”, but did not specifically name any medical conditions.  The CI did undergo lumbar epidural steroid injections in April 2003.  A MEB NARSUM addendum was written in 15 May 2003 and noted the additional treatment of the low back, however, there was no examination of the lumbar spine performed and the MEB NARSUM examiner did not determine that the CI fell below retention standards for the low back at the time.  The lumbar herniated nucleus pulposus condition was not profiled or judged to fail retention standards.  In accordance with DoDI 1332.38, adequate performance to the point of referral into the physical evaluation process supports a finding of fitness for duty, even if the condition may preclude continued military service.  There was no performance-based evidence from the record that lumbar herniated nucleus pulposus condition significantly interfered with satisfactory duty performance until after the CI was referred into the physical disability process.  After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the lumbar herniated nucleus pulposus condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the chronic neck pain and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication 

In the matter of the contended category II “history of lumbar herniated nucleus pulposus” condition IAW VASRD §4.71a, 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 modification or re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150820, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD  20762

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2015-02245.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate.  The Board recommended no re-characterization or modification of your separation.

I carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  I accept their recommendation that your application be denied.

Sincerely,

XXXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings