RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01490
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20040920

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated National Guard E4, Military Police, medically separated for “chronic neck pain” with a disability rating of 10%.

CI CONTENTION:  “Was not fairly evaluated for 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 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 (VA), 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 - 20040819	VARD - 20050914	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Neck Pain	5241	10%	Cervical Spine Degenerative Disc Disease	5243	10%	20050216	
			Left Upper Extremity Radiculopathy	8515	10%		
			Right Upper Extremity Radiculopathy	8515	10%		
Low Back Pain	Not Unfitting	Lumbar Strain with Degenerative Changes	5243	10%		
Gastroesophageal Reflux Disease		Gastroesophageal Reflux Disease	7399-7346	10%		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:

Chronic Neck Pain.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s neck pain condition began in November 2000 after moving weapons.  A C4-C5 anterior cervical discectomy and fusion was performed on 20 December 2000.  A nerve conduction study in December 2003 showed no evidence of radiculopathy or neuropathy.  Radiographic (X-ray) studies on 7 January 2004 revealed post-surgical effusion with surgical hardware in place with normal lordotic curvature noted. 

The 20 November 2003 MEB NARSUM examination, 10 months prior to separation, noted complaints of neck pain.  Physical examination showed spinal and trapezius muscles tenderness.  Straight leg raising test (for radiculopathy) was negative, upper extremity deep tendon reflexes were 1+, motor strength was normal, and sensation was intact to light touch throughout.  Range of motion (ROM) was not performed.  The 25 November 2003 MEB physical therapy examination showed ROM of flexion to 35 degrees (normal 45) and combined ROM was 165 (normal 340) without painful motion.  The 21 January 2004 MEB neurological examination note complaints of neck pain radiating to the right arm without weakness.  Physical examination showed a gait with normal heel, toe and tandem walk.  Motor strength was normal bilaterally.  Upper extremity neck ROM was decreased around the yaw axis (rotation). 

At the 16 February 2005 VA Compensation and Pension (C&P) evaluation, 5 months after separation, the CI reported constant neck pain that travels his arms and fingers but does not cause incapacitation.  Physical examination showed a gait within normal limits and spinal muscle spasms and tenderness.  ROM was flexion to 40 degrees and combined ROM was 230 with painful motion.  Repetition additionally limited ROM (actual measurement not provided) due to pain, fatigue, weakness, and lack of endurance. 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the neck pain condition 10%, coded 5241 (spinal fusion), citing painful motion.  The VA also rated the neck pain condition 10%, coded 5243 (intervertebral disc disease), citing limitation of motion.  The panel noted there was 165 degrees of combined motion recorded on the NARSUM examination 10 months prior to separation.  However, the preponderance of evidence, as reported on the MEB physical therapy and C&P examination more proximate to separation, indicated that a 10% rating, but no higher, was justified for limitation of flexion (greater than 30 degrees but not greater than 40 degrees).  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 that there was insufficient cause to recommend a change in the PEB adjudication for the chronic neck pain condition.  

Contended PEB Conditions:  Low Back Pain and Gastroesophageal Reflux Disease.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  None of the conditions were profiled, implicated in the commander’s statement nor judged to fail retention standards.  There was no performance-based evidence from the record that any of the conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions and so no additional disability ratings are recommended.

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.  In the matter of the contended low back pain and gastroesophageal reflux disease conditions, the panel unanimously recommends no change from the PEB determinations as not unfitting.  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 20161004, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment

AR20180001620, 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