RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00049
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060601

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Radio Operator/Maintainer, medically separated for “chronic neck pain” with a disability rating of 20%.  

CI CONTENTION:  The CI submitted a lengthy contention requesting that the panel review his unfitting neck pain condition as well as the radiculopathy component of the condition.  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 - 20060501	VARD - 20070118	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Neck Pain	5241	20%	Cervical Disc Fusion, C6-7, with Intermittent Left Radiculopathy	5237	20%	20060808	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

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 May 2005 after sustaining an injury during a parachute landing.  The left-handed CI complained of posterior pain/stiffness at 9/10 with pain radiating down to his left trapezius.  An MRI on 24 May 2005 showed multilevel degenerative disease worse at the C6-7 level.  There was moderate left paracentral stenosis due to a left paracentral disc protrusion.  There were no electrodiagnostic studies in the STR.  On 6 October 2005, 8 months prior to separation, the CI underwent an anterior cervical discectomy at C6-7 with cadaver body interfusion and hardware.  

Following surgery, 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 an MEB.  The MEB forwarded “chronic cervical pain, improved left arm radiculopathy” for PEB adjudication.  

At the time of the pain clinic appointment on 25 August 2005, the CI reported neck and left shoulder pain with some numbness and tingling in the fingers, with occasional pain down the entire length of the left arm.  He had not had previous injections.  The CI received a fluoroscopic‑guided left C7 nerve root block.  After the procedure, the CI reported 0/10 pain with complete resolution, with some residual numbness in the area of previous pain.  Provocative maneuvers for signs of radiculopathy or radiating pain due to spinal nerve root involvement (Spurling’s sign) were positive prior to the injection and negative following the procedure.  

On 6 October 2005, the neurosurgeon performed an anterior cervical decompression and fusion at C6-7 with a cadaver graft to address the CI’s cervical and left shoulder pain and left arm numbness.  The CI continued with physical therapy with good results initially, but continued to have some pain and “fleeting tingling” in the left forearm and dorsal hand, which was an improvement.  

The 9 March 2006 MEB NARSUM examination, 3 months prior to separation, indicated that the CI had some improvement in his radicular symptoms since his surgery.  The examiner reported cervical flexion of 25 degrees (normal 45) due to “mechanical inability, not pain.”  The examiner also noted that the CI had some mild pain with rotation, and the combined range of motion (ROM) was 165 degrees (normal 340).  Deep tendon reflexes (DTRs) were +2 on the right biceps and absent on the left biceps.  Triceps and radial DTRs were “trace” bilaterally.  There was no muscle atrophy, no spasm and muscle strength was 5/5 (normal) bilaterally.  

At the 8 August 2006 VA Compensation and Pension (C&P) evaluation, 2 months after separation, the CI reported daily aching pain localized in the lower neck.  He stated that he “no longer has the radicular pain to the left arm, but he still occasionally gets numbness in the left arm.”  He reported that his neck pain is aggravated by heaving lifting.  X-rays showed anterior fusion plate at C6-C7 with prominent prevertebral soft tissue swelling at that level.  Physical examination showed no cervical tenderness or spasm.  DTRs were normal and symmetric; sensation was intact to pinprick and light touch; and muscle strength, bulk and tone were normal.  ROM documented cervical flexion of 25 degrees (normal 45) and combined ROM of 160 degrees (normal 340) with terminal discomfort.  There was no additional functional impairment with repetition due to pain, fatigue, weakness, lack of endurance or incoordination.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic neck pain condition 20% under the 5241 code (spinal fusion), citing limitation of cervical flexion.  The VA also assigned a 20% rating using the 5237 code (cervical spine strain) for limitation of cervical flexion.  The VA noted the CI’s radicular pain, but included it in the rating as “cervical disc fusion C6-7, with intermittent left radiculopathy,” subsuming the radiculopathy under the condition code above.  

The panel agreed that a 20% rating, but no higher, was justified for limitation of flexion (greater than 15 degrees but not greater than 30 degrees) and/or combined ROM (not greater than 170 degrees), as reported on all examinations.  There was no documentation of intervertebral disc syndrome (IVDS) with incapacitating episodes which would provide for a higher rating under that formula.  

The panel noted that the PEB considered radiculopathy in its adjudication (“left radiculopathy improved”) and rendered a de facto “not unfitting” determination, and the CI contended this condition.  Radiculopathy is therefore in the panel’s scope of review and will be addressed.  

The panel next considered if additional disability rating was justified for peripheral nerve impairment due to radiculopathy.  The CI had intermittent left arm numbness and tingling symptoms, and absent left triceps DTR that was normal on the VA C&P examination.  Radiographic studies supported some level of radicular nerve irritation or involvement, but physical examinations (MEB NARSUM, and VA C&P) proximate to separation revealed no objective findings of radiculopathy that would impact duty performance.  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.  While the CI may have suffered additional pain from the nerve involvement, this is subsumed under the general spine rating criteria, which specifically states “with or without symptoms such as pain (whether or not it radiates).”  Therefore the critical decision is whether or not there was a significant neurologic impairment which would impact military occupation-specific activities.  There was no evidence in this case that a neurologic abnormality existed to any degree that could be described as functionally impairing.  The panel therefore concluded that additional disability 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.  

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.  In the matter of the contended radiculopathy condition, the panel unanimously agrees that it cannot recommend it for additional disability rating.  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 20151201, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170013348, 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. 

	A copy of this decision has been provided to the counsel you listed on your application, XXXXXXXXXXXXXXXXXXX.

Sincerely,					       
						      					
Enclosure