RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00214
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070504

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Cannon Crewmember, medically separated for “chronic neck pain” with a disability rating of 10%.

CI CONTENTION:  The CI was given a higher rating for his conditions by the VA.  The complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The Board’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 Board’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 Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’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 Board 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 Board 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 - 20070207	VARD - 20070606	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Neck Pain…	5299-5242	10%	Straightening and Reversal of the Cervical Spine Curvature with IVDS	5243-5237	20%	20060921	
RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  100%	

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 2005 with no specific injury or trauma.  Magnetic resonance imaging (MRI) studies from February 2005 showed a small area of focal dilatation, minor annular bulge, and degenerative disc disease.  Electro diagnostic studies from March 2005, were negative for radiculopathy.  There was no surgical indication.

The 29 June 2006 MEB NARSUM examination, 10 months prior to separation, noted that the CI was unable to perform activities involving lifting and carrying of ammunition, as well as heavy equipment and toolboxes. He was unable to road march, dig for firing position, or set up nets and tents.  
Physical training activities, which he was unable to perform, included activities involving running and jumping.  On physical examination, strength testing of the right upper extremity was 3/4 throughout with poor tolerance for testing.  Left upper extremity 4/5 due to pain from neck and other shoulder.  Tightness of the para cervical musculature was noted with the right more so than the left.  Tenderness to palpation was noted to the right para cervical, as well as right trapezius muscles.  Sensation to light touch and pinprick was intact throughout the upper extremities.  No effusion, edema, or muscle atrophy of the extremities was noted.  Pulses were full and equal bilaterally.  ROM measurements showed flexion at 20 degrees (normal 45), extension 25 degrees (normal 45), and combined cervical ROM of 135 degrees (normal 340) after repetition.

At the 21 September 2006 VA Compensation and Pension (C&P) examination, performed 7 months before separation, the CI reported pain which was located at the back and shoulders and occurred constantly, and stiffness.  The pain was squeezing in nature, aching in nature, oppressing and sticking in nature.  There was no incapacitation and the CI’s functional impairment was limited range of motion.  Upon examination, the CI had a normal gait.  There was no evidence of radiating pain on movements, tenderness or muscle spasms.  ROM measurements showed flexion at 30 degrees (normal 45), extension 40 degrees (normal 45), and combined cervical ROM of 220 degrees (normal 340) after repetition.  The joint function was additionally limited by pain, fatigue, and weakness following repetitive use.  It was not additionally limited by lack of endurance or incoordination after repetitive use.  There was no ankylosis of the cervical 'spine shown.  There were signs of intervertebral disc syndrome in C3 through C8.  X-rays of the cervical spine showed straightening and reversal of the curvature.  The examiner gave a diagnosis of straightening and reversal of the cervical spine curvature with IVDS.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic neck pain condition 10% using an analogous 5299-5242 code (degenerative arthritis of the spine), citing range of motion limited by pain and tenderness to palpation.  The VA assigned a 20% rating using an analogous 5243-5237 code (intervertebral disc syndrome and cervical spine strain) for limitation of forward flexion.  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) reported on the NARSUM and VA examinations.  

The panel considered whether a higher rating (§4.7) was achieved by using the alternate rating formula based on incapacitating episodes due to intervertebral disc syndrome (IVDS).  Although the CI had intervertebral disc disease there were no incapacitating episodes requiring physician-prescribed bed rest to warrant consideration of rating under the alternate VASRD formula (for IVDS).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 20% for the chronic neck pain condition, coded 5299-5242.  

BOARD FINDINGS:  In the matter of the chronic neck pain condition, the panel unanimously recommends a disability rating of 20%, coded 5299-5242 IAW VASRD §4.71a.  There are no other conditions within the Board’s scope of review for consideration.  The panel recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Neck Pain	5299-5242	20%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160405, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170014107, XXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	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 also been provided to the Department of Veterans Affairs.

Sincerely,	
Enclosure