RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00860
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20040919

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Fire Control Systems Repairer, medically separated for “chronic neck pain” with a disability rating of 10%.

CI CONTENTION:  The CI contended the following:  C-5/C-6 spinal fusion, head and neck movement has deteriorated, unemployable, Oophorectomy – ovary removed, now had uterus removed, and complications with menopause.  The CI’s 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 conditions 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 - 20040617	VARD - 20050113	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Neck Pain	5241	10%	Postoperative Residuals of Cervical Herniated Nucleus Pulposus	5243	20%	20040824	
	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Chronic Neck Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s neck condition began in 2001 without any specific injury or trauma.  She underwent cervical spine fusion, C5/C6, in April 2003.  Following surgery further treatment did not result in improvement sufficient to allow unrestricted duty.  

The MEB NARSUM examination on 30 April 2004 (5 months prior to separation) noted complaints of constant neck pain, with weakness and numbness of the entire right arm, worsened with increased activities.  Physical examination showed mild paraspinal muscle spasm and tenderness to palpation of the neck posteriorly.  Spurling test was negative.  Range of motion (ROM) of the cervical spine was obtained by physical therapist and showed a flexion of 20 degrees (normal 45) and a combined ROM of 130 degrees (normal 340).  Examination of the upper extremities showed no gross anomalies, normal reflexes, and normal strength.  Radiographic (X-ray) studies showed intact hardware at the C5/C6 level, however, the intervertebral space was still apparent, indicative of a nonunion.  On 8 January 2004 electrodiagnostic studies showed no evidence of a median/ulnar neuropathy or cervical radiculopathy.  At the time of the chiropractic clinic appointment on 25 May 2004, the CI reported occasional radiculopathy in the right arm.  Physical examination showed normal reflexes, normal strength, and ROM measurements showed a flexion of 20 degrees and a combined ROM of 150 degrees.  

At the 24 August 2004 VA Compensation and Pension (C&P) evaluation, performed 1 month before separation, the CI reported complaints of pain, weakness, stiffness, fatigability, and lack of endurance.  The CI also reported that she wore a soft cervical collar on occasion.  Physical examination showed normal posture and gait, normal strength, tenderness throughout the cervical vertebrae, and deep tendon reflexes reduced.  ROM measurements showed a flexion of 20 degrees and a combined ROM of 250 degrees.  The examiner noted that a computerized tomography (CT) scan of the cervical spine on 12 December 2003 was 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), citing without neurologic or electrodiagnostic abnormality, with cervical range of motion limited by pain, and with localized tenderness.  The VA assigned a 20% rating, coded 5243 (intervertebral disc syndrome), citing for limited 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 physical therapy, chiropractic, MEB NARSUM and VA examinations.  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 the alternate VASRD formula (for IVDS).  There was no evidence of cervical spine nerve root involvement by electrodiagnostic studies and there was no evidence of an associated unfitting radiculopathy for consideration of a separate peripheral nerve rating.  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 5241.  

BOARD FINDINGS:  In the matter of the chronic neck pain condition, the panel unanimously recommends a disability rating of 20%, coded 5241 IAW VASRD §4.71a.  There were no other conditions within the panel’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	5241	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160920, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170017102, 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 and to the counsel you listed on your application; [name and address].

Sincerely,	
Enclosure