RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02396
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050328

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a National Guard E4, Infantryman, medically separated for “chronic neck pain” and “post-concussive headaches,” rated 10% and 10%, respectively, with a combined disability rating of 20%.  

CI CONTENTION:  CI complains of his migraine headaches and lack of sleep.  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 - 20050317	VARD - No VA Disability Claim	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Neck Pain	5237	10%	*No VA evidence	
Post-Concussive Headaches	8045-9304	10%		
COMBINED RATING:  20%	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 pain condition began in January 2004 after he was flung forward in a military vehicle while on training.  He sustained a whiplash injury to the neck and blunt trauma to chest area.  He reported to sick call complaining of neck pain and recurrent headaches.  He was prescribed over-the-counter medication and given a temporary profile.  A follow-up X-ray of his neck revealed normal limits for his cervical spine.  The CI was referred to physical therapy for approximately 2 months with no symptom relief.  In July 2004 he was referred for chiropractic care.  Magnetic resonance imaging (MRI) performed in August 2004 revealed a single-level mild neuro foramina narrowing and rest of exam was within normal limits.  He remained under chiropractic care until September 2004 but his neck pain worsened.  He underwent acupuncture therapy without resolution of his neck pain.  Biofeedback attempts were made for several months without resolution of symptoms.  Despite treatment, the cervical spine condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for MEB.  The MEB forwarded chronic neck pain for PEB adjudication.  The 11 February 2005 MEB NARSUM examination, 2 months prior to separation, noted complaints of neck pain.  The CI was treated with biofeedback for neck pain for several months without symptom relief.  Lidocaine injections made neck pain worse.  The physical exam showed limitation of motion due to pain.  Spurling test (assesses nerve root pain) was negative.  Imaging studies noted previously were within normal limits.  There was no VA Compensation and Pension evaluation in evidence.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the neck 10%, coded 5237 (cervical strain), citing full range of motion and some para spinal tenderness.  There was no VARD in record.  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 and/or combined ROM (greater than 170 degrees but not greater than 335 degrees) reported on applicable examinations proximate to separation.  There was no muscle spasm or guarding severe enough to result in 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 chronic neck pain condition.  

Post-Concussive Headaches.  According to the STR and the MEB NARSUM, the CI’s occipital headaches condition began in January 2004 after he was flung forward in a military vehicle while on training.  He sustained a whiplash injury to the neck and blunt trauma to the chest area.  He reported to sick call complaining of recurrent headaches.  He was treated with pain medication and muscle relaxants with minimal temporary relief.  Several months of biofeedback provided no symptom relief.  The CI was referred to neurology in November 2004 for continuation of chronic headaches.  A follow on MRI study of the brain revealed multiple small foci predominantly located in the frontal, right temporal and left occipital regions, which led to a neurological diagnosis of migraine headaches.  Lidocaine injections to treat both his cervical and trapezius regions exacerbated the headaches.  Despite treatment, the headaches condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for a MEB.  The MEB forwarded “post-concussion syndrome, severe” and “migraine without aura, severe” for PEB adjudication.  

The neurology specialty MEB consultation, dated 19 January 2005, 2 months before separation, diagnosed 1) post-concussive syndrome, severe, and 2) migraine without aura, severe.  The 11 February 2005 MEB NARSUM examination, 2 months prior to separation, noted occipital headaches.   As previously noted, the CI was treated with biofeedback for several months without symptom relief and lidocaine injections made headaches worse.  The physical examination noted a neurological diagnosis of post-concussion syndrome and migraines without aura.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the headaches 10%, analogously coded 8045-9304 (brain disease due to trauma), citing headaches continuing for one year and normal imaging.   Review of service treatment records in the 12 months prior to separation does not show prostrating headaches occurring on average once per month or more frequently to support a rating higher than the 10% adjudicated by the PEB.  The panel concluded there was no evidence to support a rating higher than the rating adjudicated by the PEB.  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 post-concussive headaches condition.  

BOARD FINDINGS:  In the matter of the cervical neck pain condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the post-concussive headaches condition and IAW VASRD §4.124, the panel recommends no change in the PEB adjudication.  There were 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 20150801, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170007476 , XXXXXXXXXXXXXXXXXXXXX 

XXXXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXXXX:

	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