RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01061
BRANCH OF SERVICE:  army 	SEPARATION DATE:  20040315

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Supply Specialist, medically separated for “chronic neck pain due to C4-5, C5-6 herniated nucleus pulposus without neurologic abnormality” with a disability rating of 10%.  

CI CONTENTION:  He was given a higher rating for his conditions by the VA.  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 - 20031211	VARD - 20040624	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Neck Pain Due To C4-5, C5-6 Herniated Nucleus Pulposus Without Neurologic Abnormality	5243	10%	Herniated Nucleus Pulposus C4-C5 And C5-C6 With Degenerative Disk Disease (DDD) C3-C6	5243	20%	20040114	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20% 	

ANALYSIS SUMMARY:  

Chronic Neck Pain ...  According to the service treatment record and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s chronic neck pain condition began in 1999 after a sudden onset of pain of the posterior neck with pain radiating from the neck into the right upper extremity.  There was no specific injury or trauma associated with the condition.  During the 5 August 2002 primary care clinic appointment, the CI denied any numbness or tingling but had mild neck pain with movement.  The pain was aggravated by carrying a rucksack wearing Kevlar and prolonged use of load-bearing equipment.  The examiner noted some mild discomfort, but the CI was able to turn the neck in both directions.  The physician prescribed continued stretching exercises along with muscle relaxants.  

At the 21 April 2003 primary care clinic appointment, the CI reported neck pain with shooting pain down the shoulders.  Pain intensity was described as 7/10.  Physical examination showed full range of motion (ROM) and normal strength.  MRI studies on 2 May 2003 showed DDD with right paracentral disc extrusion at C4-C5 and C5-C6.  No other abnormalities were seen.  During the 3 October 2003 orthopedics appointment, the CI reported sharp pain when rotating the head to the right.  He was no longer able to carry his child and already had a P2 profile.  He did not want to try any chiropractic treatment, physical therapy, injections, or surgery and wished to proceed with an MEB.  At the primary care clinic appointment on 27 October 2003, the CI reported constant neck pain which radiated down the neck to the right arm.  Pain intensity was reported as 8/10 but increased to a 10/10 when the neck rotated to the right.  On examination the neck was noted to be tender with no evident swelling.  

The 17 November 2003 MEB NARSUM examination, 4 months prior to separation, noted complaints of neck pain with strain in the cervical paraspinal muscles.  Physical examination showed cervical spine ROM of flexion 25 degrees (normal 45) and combined ROM 185 degrees (normal 340) before he started to have a significant amount of pain and increased radicular symptoms.  Examination of the upper extremity revealed a decrease in light touch sensation in the C6 distribution on the right, as well as 5/5 wrist extension, wrist flexion, biceps, triceps, and deltoid strength on both sides.  Upper extremity reflexes were normal.  Cervical MRI studies showed herniated discs at C4-C5 and C5-C6.  The CI was diagnosed with C4-C6 herniated discs with moderate loss of cervical spine ROM and moderate cervical strength with neuritis in the C6 distribution on the right.  

At the 14 January 2004 VA Compensation and Pension (C&P) evaluation, 2 months before separation, the CI reported continued chronic posterior neck pain and increased discomfort with prolonged positioning and wearing of his Kevlar helmet.  Physical examination showed gait, posture, and balance as normal with the neck supple, and with some impairment of mobility.  The extremities were symmetrical with no swelling or inflammation and no tenderness on the vertebrae or midline.  Pulses were good and symmetrical.  ROM testing revealed no evidence of discomfort or loss of mobility.  Neck ROM was active flexion to 45 degrees and combined ROM 260 degrees.  There was no evidence of palpable spasm or tenderness.  Neck ROM testing revealed evidence of discomfort in the neck with rotation being limited to 45 degrees (normal 80) both left and right.  There was no evidence of any additional limitation by pain, fatigue, weakness, or lack of endurance, locking, or instability following repetitive movement.  There was evidence of mild loss of lower back and neck normal curvature.  The examiner noted there was no additional objective evidence of any postural abnormalities, fixed deformity, painful motion, edema, effusion, instability, weakness, tenderness, redness, heat, abnormal movement, guarding of, inflammatory signs of arthritis or constitutional signs.  Cervical spine X-rays on 14 January 2004 showed loss of cervical lordosis with DDD and spinal arthritis.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the neck condition 10%, coded 5243 (intervertebral disc syndrome), citing limitation of motion.  The VA rated the neck condition 20%, also coded 5243, based on the C&P examination 2 months before separation, citing the VARSD 20% rating criteria.  

The neck ROM at the MEB NARSUM examination, 4 months before separation, supported a 20% rating for limitation of flexion (greater than 15 degrees but not greater than 30 degrees).  However, the panel agreed that a 10% rating, but no higher, was justified at separation for limitation of flexion (greater than 30 degrees but not greater than 40 degrees) or combined ROM greater than 170 degrees but not greater than 335 degrees, as reported on the VA examination most proximate examination to separation.  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.  The panel noted the 14 January 2004 X-rays reported loss of cervical spine lordosis suggestive of muscle spasm.  However, there was no examination evidence at the time of the X-ray that confirmed the presence of muscle spasm causing the altered contour.  The panel considered whether a higher rating (§4.7) was achieved by using the alternate rating formula based on incapacitating episodes due to intervertebral disc syndrome.  Although the CI had intervertebral disc disease there were no 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 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.  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 20160927, w/atchs  
Exhibit B.  Service Treatment Record  
Exhibit C.  Department of Veterans Affairs Treatment Record  

AR20180001943, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

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