RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02336
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20030820

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Light Wheeled Vehicle Mechanic, medically separated for “chronic neck pain”, with a disability rating of 20%.

CI CONTENTION:  The CI made no specific contention.  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 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 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 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 - 20030609	VARD - 20031105	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Neck Pain	5099-5003	20%	Residuals, DDD Cervical Spine	5243-5237	10%	20030808	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Chronic Neck Pain.  According to the service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s chronic neck pain began in 1992 after he was hit in the face with a 50 caliber machine gun barrel that came loose from its mount, causing the gun’s barrel to swing down and strike him.  The 8 April 2003 MEB NARSUM examination, 4 months prior to separation, noted an 11 year history of neck pain.  The CI experienced 5/10 pain in intensity at rest, with left arm pain.  Physical examination showed 5/5 strength in the upper extremities and the CI was otherwise intact neurovascularly.  The CI did experience a positive exacerbation of his left arm with compression of his neck (axial loading).  The examiner documented “he has full range of motion of his neck with pain in all range of motion.”  The examiner cited an Magnetic Resonance Imagining (MRI) study (no date; and study not in evidence) which showed C3-C4, C4-C5, and C5-C6 degenerative disc disease.  During the 17 April 2003 MEB examination (recorded on DD Forms 2807-1 and 2808), 4 months prior to separation, the CI reported a painful shoulder due to a spine injury with associated tingling and numbness in his left hand.  Physical examination showed deep tendon reflexes (DTRs) within normal limits with decreased sensation of the dorsum of the left hand in the radial nerve distribution.  The cervical spine range of motion (ROM) measurements were recorded in terms of percentage of full ROM lost in measured planes.  Flexion was noted as decreased by 10% (interpreted as 40 degrees forward flexion [normal 45]).  Combined ROM could not be ascertained as the examiner did not measure all ratable planes of motion.  An 18 August 2003 electrodiagnostic (EDX) study (electromyogram [EMG]/nerve conduction velocity [NCV]) was normal with no evidence of cervical radiculopathy (nerve root irritation or injury) or ulnar nerve entrapments.  At the 22 August 2003 VA Compensation and Pension (C&P) general medical evaluation, 2 days after separation, the CI reported persistent neck pain, occurring 2 times per week.  The pain usually occurred in the morning with stiffness, became better with movement, and eventually resolved after an hour.  There was no reported history of motor dysfunction.  The CI experienced left arm numbness with pressure, causing his small, index, and ring fingers to become numb.  Turning his head to the left elicited radicular pain into the left shoulder and down the left arm into the hand.  Physical examination showed no acute tenderness about the cervical spine and the CI was neurovascularly intact.  Pain-limited cervical spine active ROM was flexion of 45 degrees (45 normal), extension of 45 degrees ( normal 45), right lateral flexion of 35 degrees (normal 45), left lateral flexion of 40 degrees (normal 45), right rotation of 70 degrees (normal 80), left rotation of 60 degrees (normal 80), and combined of 295 degrees (normal 340).  There was left sided pain with bilateral lateral flexion.  The examiner recounted the findings of the normal EDx.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic neck pain condition 20%, analogously coded 5099-5003 (arthritis, degenerative), citing rating criteria of the US Army Physical Disability Agency (USAPDA) pain policy.  The VA rated the chronic neck pain condition 10% coded 5243-5237 (cervical strain), based on the VA C&P examination 2 days after separation, citing combined ROM of the cervical spine greater than 170 degrees but not greater than 335 degrees.  The panel concluded there was no evidence to support a rating higher than the rating adjudicated by the PEB.  In addition, there was no documentation of intervertebral disc syndrome with incapacitating episodes which would provide for a higher rating under that formula, or evidence of ratable peripheral nerve impairment which would provide for additional rating.  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 chronic neck pain condition.  

BOARD FINDINGS:  In the matter of the chronic neck pain condition and 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 re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150908, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170012491, XXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

	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,					      
						      					
Enclosure