RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01166
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20040525

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an National Guard E5, Security Forces Specialist, medically separated for “chronic cervical pain” with a disability rating of 10%.  

CI CONTENTION:  “Continuous problems, pain, constantly worse effects my everyday / 17 years/9 months/23 days total service I deserve better.”  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 - 20040113	VARD - 20040825	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Cervical Pain 	5242	10%	C4-C5 Herniated Disk 	5241	20%	20040226	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30% 	

ANALYSIS SUMMARY:  

Chronic Cervical Pain.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent cervical spine surgery with discectomy in December 2002.  The CI apparently recovered well enough from this procedure to deploy, whereupon in May 2003 he suffered a whiplash injury when he struck his head on a machine gun causing pain and neurologic impairment in his left arm.  A subsequent magnetic resonance imaging (MRI) in June 2003 showed the cervical vertebral bodies in anatomic alignment with expected post-operative changes at the C5-C6 vertebra level.  A right central disc extrusion (herniated disc) at the C4-C5 level was noted.  No further surgery was recommended.  An electromyogram/nerve conduction velocity (EMG/NCV) study in June 2003 showed evidence of cervical spine radiculopathy with active denervation (interruption of nerve transmission) in the left lower cervical paraspinal muscles.  

During a 4 September 2003 pain management epidural steroid injection (ESI) procedure, 9 months after surgery and 9 months prior to separation, physical examination showed the CI’s neck was supple.  He experienced discomfort with flexion, extension and rotation of the cervical spine but no tenderness was noted with the exception of the medial scapula in the right upper back.  There was no sensory deficit or weakness in the upper extremities.  

A 7 October 2003 neurosurgery consult (written by the neurosurgeon who performed the above mentioned surgery), 10 months after surgery and 8 months prior to separation, noted the CI had undergone ESI procedures which were deemed helpful.  The CI reported that he felt much better.  However, the examiner recommended the CI refrain from active duty military activities for the time being and he was further referred to physical medicine and rehabilitation for subsequent treatment.  

At the 12 October 2003 physical medicine and rehabilitation examination the CI reported his neck pain was “largely improved.”  Existing pain was intermittent and weather dependent.  The examiner noted the CI was there to determine whether or not he could return to work as a police officer.  Physical examination showed full range of motion (ROM) of the neck in all planes.  Minimal discomfort was noted at the end of the range.  Upper extremity muscle strength, sensation and reflexes were normal.  The examiner concluded:  “I would not restrict any (of the CI’s) duties to perform his job as a police officer…I would only restrict (the CI’s) activities to be weight bearing or load inducing to his neck such as wearing a heavy helmet.”  

At the 12 December 2003 MEB NARSUM examination, 12 months after surgery and 6 months prior to separation, physical examination showed a supple neck with mild discomfort noted on flexion, extension and rotation of the cervical spine.  Neuro motor examination was normal.  The examiner noted that the CI’s Commanding Officer strongly recommended retention in the Air Force.  The examiner concluded the CI’s “condition has resolved and he has no limitations and his overall risk of recurrence is low.”  

At the 2 February 2004 VA Compensation and Pension (C&P) evaluation, 4 months prior to separation, the CI reported constant pain which varied in intensity.  He reported being unable to do any kind of sports with running or training.  Physical examination showed tenderness around the entire posterior neck.  The CI held his head very straight and could not turn his head much.  He had 30 degrees forward flexion (normal 45) and 145 degrees combined ROM (normal 335).  Neurologic examination was normal with the exception of slight decrease in sensation in fingers 4 and 5 of the left hand.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the cervical spine pain 10%, coded 5242 (degenerative arthritis of the spine).  The VA rated the cervical spine pain 20%, coded 5241 (spinal fusion), citing forward flexion of the cervical spine greater than 15 degrees but not greater than 30 degrees, or the combined range of motion of the cervical spine not greater than 170 degrees.  

Although there was insufficient limitation of motion to support a 10% rating as reported on the MEB NARSUM and rehabilitation medicine proximate to separation, the panel agreed a 10% rating was justified for the presence of painful motion and tenderness.  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 (IVDS) with incapacitating episodes which would provide for a higher rating under that formula.  The ROM values reported by the VA examiner (4 months before separation) were significantly worse than those reported by MEB NARSUM and rehabilitation medicine examiners proximate to this examination. There was no record of recurrent injury or other development in explanation of the more marked impairment reflected by the VA measurements.  While ROM limitations may have progressed over time, there was no evidence in the record from which to conclude that the severity at separation approached that portrayed by the VA measurements.  Members agreed that the MEB NARSUM and rehabilitation medicine examinations were more consistent with the STR and more reflective of the anticipated severity based on the clinical pathology.  Furthermore, these examiners specifically annotated the CI’s condition had resolved and that he should be returned to normal duties (one of these examiners recommended the CI resume duties in his occupation of police officer).  The panel therefore relied more heavily on the MEB NARSUM and rehabilitation medicine examinations.  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 cervical pain condition.  

BOARD FINDINGS:  In the matter of the chronic cervical 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 20160922, 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-2016-01166.

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,

XXXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings