RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00373
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20051208

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an Air National Guard E6, Fuel System Technician, medically separated for “chronic neck pain secondary to congenital hemivertebra (C3) and fusion (C3-4)” with a disability rating of 10%.  

CI CONTENTION:  Requests review of 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 - 20051004	VARD - 20061010	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Neck Pain Secondary to Congenital Hemivertebra (C3) and Fusion (C3-4)	5299-5241	10%	Congenital Hemivertebra C-3. Fusion of C3 and C-4, Spondylosis with Stenosis	5299-5241	NSC	STR	
Hypertension	Not Unfitting	Hypertension	7101	NSC	STR	
Mild Hearing Loss	Not Unfitting	Left Ear Hearing Loss	6100	0%	20060907	
		Right Ear Hearing Loss	6100	NSC	20060907	
Hyperlipidemia	Not Unfitting	Hyperlipidemia	7399-7345	NSC	STR	
Overweight	Not Unfitting	No VA Entry/Not Compensable	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Chronic Neck Pain Secondary to Congenital Hemivertebra (C3) and Fusion (C3-4).  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), this Air National Guard CI had a longstanding neck pain condition with diagnostic imaging demonstrating hemivertebra at C3 and partial anomalous fusion of C3 and C4 with stenosis at C4-5, C5-6 and C6-7 (developmental anomalies).  Despite this condition, the CI was able to perform duties and was at annual training (AT) in November 2003 when he reported feeling a “pop” in his neck while performing sit-ups.  A subsequent line of duty investigation determined that the physical training injury constituted service aggravation of an EPTS (existed prior to service) condition.

At the 18 November 2004 spine clinic consult, 13 months prior to separation and 12 months after his AT incident, he reported neck pain on and off with activity, exacerbated by recent experience which was treated successfully with anti-inflammatory medication.  Physical examination showed a non-antalgic gait with painless range of motion (ROM).  The examiner did not provide specific ROM measurements but stated that lateral bending to the right was limited by about 10 degrees compared to the left and rotation was limited by about 10 degrees compared to the left.  His assessment was hemivertebra C3 with levoscoliosis at C2 to C4 and partial fusion at C3 and C4, and subaxial cervical spondylosis with moderate stenosis and no evidence of radiculopathy or myelopathy.  

The 3 March 2005 MEB NARSUM examination, 9 months prior to separation, noted complaints of persistent neck pain.  Physical examination showed no deformities or tenderness to palpation.  Specific ROM measurements were not provided, but the examiner noted full ROM other than decreased lateral bending and rotation with right less than left by approximately 15 degrees.  Spasm, spinal contour, gait, and painful motion were not mentioned.  There was no VA examination in evidence proximate to separation.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the neck pain condition 10%, coded 5299-5241 (analogous to spinal fusion).  The VA denied service-connection for the neck condition, based on the STR, citing that the evidence did not show that the congenital abnormality was permanently worsened as a result of active military service.  The panel agreed that a 10% rating, but no higher, was justified for combined ROM (greater than 170 degrees but not greater than 335 degrees), as reported on the November 2004 spine clinic consult and the MEB NARSUM examination.  Although these two reports did not provide specific numeric ROM measurements, it can be deduced from the limited right side lateral bending and rotation entries that full ROM was not achieved and the limitations are consistent with the 10% rating criteria.  There was no muscle spasm or guarding severe enough to result in an abnormal gait or spinal contour, thus the next higher 20% rating was not justified on this basis.  There was no documentation of intervertebral disc syndrome (IVDS) with incapacitating episodes which would provide for a higher rating under that formula.  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 condition.  

Contended PEB Conditions:  Hypertension, Mild Hearing Loss, Hyperlipidemia, and Overweight.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  None of the conditions were implicated in the commander’s statement nor judged to fail retention standards.  Only the hearing loss condition was profiled, but it was H2 and there were no duty restrictions associated with the profile.  The overweight condition is not compensable and therefore not ratable.  There was no performance-based evidence from the record that any of the conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the neck pain condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the contended hypertension, mild hearing loss, hyperlipidemia, and overweight conditions, the panel unanimously recommends no change from the PEB determinations as not unfitting.  There are no other conditions within the panel’s scope of review for consideration.  Therefore, the panel recommends 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 20150610, w/atchs
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

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2016-00373.

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.  Accordingly, the Board recommended no re-characterization or modification of your separation.

I have 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.  Accordingly, I accept their recommendation that your application be denied.

Sincerely,

Attachment:
Record of Proceedings