RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00501
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20050718

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Fire Protection Apprentice, medically separated for “chronic neck pain” with a disability rating of 10%.  

CI CONTENTION:  The CI made no specific contention.  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 at the time of separation.  The panel has neither the role nor the authority to compensate for progression or complications of service-connected conditions after separation.  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 - 20050531	VARD - 20060222	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Neck Pain	5241	10%	Post-Operative Residuals of Cervical Spine Herniated Nucleus Pulposus	5243	20%	20060124	
COMBINED RATING:  10%	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 underwent cervical spine surgery with a C6-C7 anterior cervical decompression and fusion for a herniated disc on 5 February 2004.  The surgery relieved the CI’s right arm radiculopathy symptoms; however, the CI reinjured his neck approximately 8 months after surgery and he continued to experience recurrent neck pain daily.  Follow up evaluation by the neurosurgeon recommended no further surgery.  At the 3 February 2005 physical therapy appointment, 4 months prior to separation, the CI reported “he feels pain is bearable.”  Physical examination showed no paraspinous muscle tension.  The examiner noted that the CI wasn’t interested in further physical therapy and was interested in separation.  

The 17 February 2005 MEB NARSUM examination, 3 months prior to separation, noted complaints of intermittent posterior neck pain.  Physical examination showed mild decrease range of motion (ROM) all directions; there was mild tenderness to the lower cervical area.  The examiner noted that magnetic resonance imaging (MRI) on 1 November 2004 showed post-operative changes with no significant spinal canal, lateral recess or neural foraminal stenosis.  There were no ROM measurements in evidence before separation.  

At the 24 January 2006 VA Compensation and Pension (C&P) examination, 8 months after separation, the CI reported soreness and tenderness in the bottom of his neck that was constant, pain averaged 6/10, and occasionally went to 8-9/10 if he did anything strenuous or jogging.  He reported occasional muscle spasms.  He did report one incapacitating episode over the previous year that lasted for one day after wrestling with a friend.  Physical examination showed normal curvature and no tenderness on palpation.  ROM measurements showed forward flexion of 35 degrees (normal 45) and a combined ROM of 290 degrees (normal 340) with painful motion noted.  There was no mention of muscle spasms.  The examiner reported that radiographic (X-ray) studies 24 January 2006 showed evidence of previous anterior spinal fusion at the C6-7 level, no evidence of compression fracture, intervertebral spaces were maintained, and there was a decrease in lordosis.  MRI study on 2 February 2006 showed previous surgery with hardware placement anteriorly in the lower cervical spine, no signs of cord compression or spinal stenosis, and neural foramina and facet joints were normal.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the neck condition 10%, coded 5241 (spinal fusion).  The VA rated the neck condition 20% coded 5243 (intervertebral disc syndrome), citing “granted for abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis.”  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 combined ROM (greater than 170 degrees but not greater than 335 degrees), as reported on the VA examination and for the tenderness of the cervical area reported on the MEB NARSUM.  There was no evidence of 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 evidence of intervertebral disc syndrome (IVDS) which resulted in incapacitating episodes requiring physician-prescribed bed rest to warrant consideration of rating under that alternate VASRD 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 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 modification or re-characterization of the CI’s disability and separation determination. 

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20131218, w/attachments
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

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2016-00501.
	
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.  The Board recommended no re-characterization or modification of your separation.

I 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.  I accept their recommendation that your application be denied.

Sincerely,

Attachment:
Record of Proceedings