RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00691
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20041202

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a Reserve E6, Motor Transport Operator, medically separated for “chronic neck pain radiating into the left upper extremity” with a disability rating of 10%.

CI CONTENTION:  Current condition supports a higher rating.  Additional unfitting conditions were not considered.  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 - 20041008	VARD - 20060228	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Neck Pain	5237	10%	DDD, Cervical Spine C5-C6	5237	10%	20051221	
			Left Upper Extremity Radiculopathy	8715	10%	20051221	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:

Chronic Neck Pain.  According to the service treatment record (STR) and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s neck condition began in February 2004 after a 5-ton vehicle in which he was riding hit a bump resulting in the CI banging his head on the roof causing pain to radiate down through his body.  At an orthopedic examination on 6 July 2004 the CI reported feeling a squeezing pain in the left trapezius and numbness in the C6 area.  Electro-diagnostic studies on 7 July 2004, 5 months before separation, were normal.  Magnetic resonance imaging (MRI) on 7 July 2004 demonstrated minimal disk disease at C4-C5, mild facet hypertrophy at C5-C6 with foraminal narrowing, and left nerve root compression.  During the primary care evaluation on 14 July 2004, the CI reported neck pain with left upper extremity numbness.  Physical examination showed bilateral upper extremity neurological and motor strength testing results were normal except for a decrease in the left thumb sensation.  Range of motion (ROM) measurements were flexion to 30 degrees (normal 45) and combined ROM was 230 degrees (normal 340).  Gait, spinal contour, tenderness, spasm and painful motion were not addressed. 

The 17 August 2004 MEB NARSUM examination, 4 months prior to separation, noted complaints of neck pain with left cervical radicular symptoms since February 2004.  Physical examination showed the CI ambulating without an assistance device.  There was spinal muscle spasm present.  Motor strength was 5/5 and deep tendon reflexes were 2/2 throughout.  There was decreased sensation in the C6 dermatome of the left hand.  ROM measurements were flexion to 35 degrees and the combined ROM was 280 degrees with painful motion.  Gait, spinal contour and tenderness were not addressed. 

At the 28 September 2004 VA Compensation and Pension (C&P) general evaluation, 2 months before separation, the CI reported chronic neck pain with some left arm numbness that caused difficulty with buttoning his shirt or gripping things and some decreased sensation.  Physical examination showed the ability to heel and toe walk.  ROM was flexion to 10 degrees and the combined ROM was 215 degrees with painful motion. 

At a neurosurgical consultation on 23 May 2005, 5 months after separation, the CI complained of pain in the left lower neck, radiating out into the suprascapular region to the shoulder, but not into the arm.  Neurologic evaluation was unremarkable except for a slightly decreased pinprick, and at times, light touch over the left thumb.  An 18 July 2005 MRI demonstrated relatively mild degenerative disk disease changes encroaching on the left lateral recess and neural foramen (where nerves traverse the vertebral column) at the C5-6 level.  At the 21 December 2005 C&P spine evaluation, 13 months after separation, the CI reported persistent neck pain that sometimes radiated to the left arm and hand.  Physical examination showed ambulation without an assistive device.  Spinal tenderness and muscle spasm were present.  ROM flexion was to 45 degrees and the combined ROM was 330 degrees with painful motion.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the neck condition 10%, coded 5237 (cervical strain), citing 35 degrees of forward flexion without objective signs of radiculopathy.  The VA also rated the neck condition 10%, coded 5237, based on the C&P examination 13 months after separation, citing limitation of motion.  Additionally, the VA rated left upper extremity radiculopathy 10%, coded 8715 (neuralgia, median nerve, mild paralysis), citing incomplete paralysis of hand movements, which were mild.  

The panel deliberated on the probative value of the disparate examinations in evidence and judged that the C&P examination 2 months before separation documenting flexion to 10 degrees was an outlier not indicative of the preponderance of ROM evidence found in the STR and subsequent VA examination.  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) as reported by the MEB NARSUM, 4 months before separation; while the VA spine examination, 13 months after separation, supports a 10% rating based on localized tenderness not resulting in abnormal gait or spinal contour.  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 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 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 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 20160914, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment

AR20170016862, 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