RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00654
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20041201

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

CI CONTENTION:  Review 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 - 20041014	VARD - 20041223	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Neck Pain	5299-5242	20%	Degenerative Disc Disease, 
C6-C7 Cervical Spine	5243	10%	20041123	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Chronic Neck Pain.  According to service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s chronic neck pain was insidious in origin.  Magnetic resonance imaging (MRI) on 11 February 1997 showed degenerative disk disease at the C6-7 level and on 5 March 1997 an MRI demonstrated straightening of the cervical spine may be secondary to muscle spasm, C6-7 degenerative disc disease with moderate sized right paracentral herniated nucleus pulposus, and a C5-6 mild central disc bulge.  A note dated 11 October 2002 indicated the CI had isolated neck pain in the past, which improved with rest and heat, but the neck pain radiated down his right arm for 4 days.  Treatment consisted of Toradol (ketorolac, a nonsteroidal anti-inflammatory drug (NSAID)), Motrin (ibuprofen, an NSAID), and Flexeril (cyclobenzaprine, a muscle relaxer).  The chronic neck pain progressed to include periodic right arm symptoms, with eventual constant paresthesias in the right C6 distribution.  An MRI study in October 2002 showed degenerative changes and cervical spondylosis (arthritis) of the C4-C7 vertebrae.  Bone marrow edema was noted at the C5-C6 level and a reversed cervical curvature was demonstrated.  In January 2004 the CI complained of pain in the right C6 distribution when he put on Kevlar.  The CI was offered ACDF (anterior cervical diskectomy and fusion) surgery, but he declined, which was deemed reasonable given the uncertain outcome of such a procedure and his ability to resume normal duties of his MOS post-surgery.  

During the 29 March 2004, MEB examination (recorded on DD Form2807-1, dated 20 February 2004, and DD Form 2808), 8 months prior to separation, the CI reported experiencing a burning sensation in the back of his left shoulder after wearing LBE (load bearing equipment) for an extended period of time.  He also reported his right arm and index finger went numb and tingled throughout the day.  The physical examiner checked normal for the spine in the clinical evaluation.
  
The 18 May 2004 MEB NARSUM examination, 6 months prior to separation, noted complaints of the CI being unable to wear Kevlar or anything on the shoulders due to neck pain. The CI had no relief with physical therapy, chiropractic treatment or a TENS (transcutaneous electrical nerve stimulation) unit.  Physical examination was largely deferred to physical therapy for ROM measurements.  Physical therapy conducted its evaluation for ROM purposes on 14 June 2004, 6 months prior to separation.  Flexion was 30 degrees (normal 45) and the combined range of motion (ROM) was 145 degrees (normal 340).  The physical therapist documented right index finger numbness after all ROM measurements.  On 8 November 2004, 1 month before separation, the CI underwent electrodiagnostic (nerve conduction velocity and electromyogram) studies, the results of which were normal.  

At the 23 November 2004 VA Compensation and Pension (C&P) evaluation, 1 week before separation, the CI reported discomfort in the posterior neck with increased discomfort with repetitive movement and with prolonged positioning.  He also experienced increased discomfort while wearing field gear, including his helmet.  Physical examination documented a normal gait, posture, and balance.  ROM measurements were 45 degrees flexion (normal) and a combined ROM of 340 degrees (normal).  There was no indication of painful motion and there was no tenderness or neurologic deficit.  The only abnormal finding was a slight loss of curvature of the neck.  X-rays of the cervical spine demonstrated straightening of normal curvature of the upper cervical spine on the lateral view, which may represent muscle spasm.  Degenerative changes were present at C5-6 and C6-C7 with marked narrowing of disk spaces.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic neck pain condition 20%, coded 5242 (degenerative arthritis of the spine), citing cervical forward flexion of 30 degrees without neurologic or electrodiagnostic abnormality.  The VA rated the chronic neck pain condition 10%, coded 5243 (intervertebral disc syndrome), based on the C&P examination 1 week before separation, citing a normal ROM of the cervical spine, with complaints of pain and evidence of muscle spasm.  

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 the NARSUM examination.  There was no documentation of intervertebral disc syndrome 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 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 20160913, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170016341, 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.

Sincerely,					      
						      					
Enclosure