RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01697
BRANCH OF SERVICE:  MARINE CORPS	SEPARATION DATE:  20041231

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Aircraft Rescue and Firefighting Specialist, medically separated for “cervical strain” with a disability rating of 10%.  

CI CONTENTION:  The CI contends his neck and nerves have worsened.  Additionally, his hearing loss has increased.  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 -20041103	VARD - 20051128	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Cervical Strain	5237	10%	Cervical Soft Tissue Injury with Degenerative Disc Changes	5237-5243	20%	20051017	
DDD of the Cervical Spine	Cat II					
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Cervical Strain.  According to the service treatment record (STR) and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s cervical strain condition began in December 2003 when he presented with complaints of neck pain and headaches with weight lifting, and was exacerbated in May 2004 when his car was struck from behind in a motor vehicle accident (MVA).  He was diagnosed with a cervical strain and treated with narcotics, anti-inflammatory medications, muscle relaxants, and chiropractic services without relief.  A referral to neurology and an MRI in June 2004 revealed bulging discs at several levels with mild narrowing of the right C3-C4 neural foramen.  The CI was diagnosed with cervical strain, neck pain, and degenerative disc disease (DDD) of the cervical spine.  No surgical intervention was recommended.  

At the 9 August 2004 physical therapy (PT) consultation, 5 months prior to separation, the CI complained of increased lower neck pain since his MVA.  Examination showed cervical range of motion (ROM) with flexion of 60 degrees (normal 45) and combined ROM of greater than 225 degrees and less than 325 degrees (normal 340), with painful right rotation.  

The 15 October 2004 MEB NARSUM examination, 3 months prior to separation, noted CI complaints of neck pain that prevented him from sitting for greater than an hour or performing physical training or other low-impact exercise.  Physical examination showed cervical flexion 60 degrees and combined ROM greater than 205 degrees but less than 305 degrees.  There was minimal spinal tenderness without muscle spasm.  

At the 17 October 2005 VA Compensation and Pension (C&P) evaluation, 11 months after separation, the CI reported that in April 2004 his car was struck by another car resulting in a whiplash type of injury.  He reported chronic neck pain.  An MRI completed in March 2005 showed degenerative disk changes centered to the right of midline at C3-4.  Neck pain was worsened by turning his head, slumping forward, and sitting with his head bent.  Physical examination showed tenderness about C7 to T2 and to the strap and trapezius muscles bilaterally.  ROM showed forward flexion to 20 degrees and combined ROM of 110 degrees, with the CI experiencing pain with all ranges of motion.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the cervical strain condition 10%, coded 5237 (cervical strain).  The PEB also listed DDD of the cervical spine as a related Category II condition that contributed to the primary unfitting condition but was not separately ratable.  The impairment from the DDD was properly subsumed under the overall rating for the cervical strain category I condition IAW §4.14 (avoidance of pyramiding; more than one rating based on the same impairment is prohibited).  The VA rated the cervical strain condition 20%, coded 5237-5243 (cervical strain - intervertebral disc syndrome) based on the C&P examination, citing cervical spine forward flexion greater than 15 degrees but not greater than 30 degrees.  

In assigning probative value to these somewhat conflicting examinations, the panel noted that the NARSUM measurements were consistent with other proximate (pre-separation) examinations by PT and chiropractic, and were closest to separation.  Review of the STR did not detail any further injury or worsening of the condition prior to separation, and the NARSUM measurements were consistent with the diagnostic and clinical pathology in evidence.  The VA examination’s probative value was judged to be compromised by its remoteness (11 months) from the date of separation, and likely reflected post-separation worsening.  Therefore, based on all evidence and associated conclusions just elaborated, panel consensus was that preponderant probative value should be assigned to the NARSUM ROM examination.  

The panel agreed that a 10% rating, but no higher, was justified for limitation of combined ROM (greater than 170 degrees but not greater than 335 degrees), as reported on the NARSUM examination and other evaluations proximate 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.  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 cervical strain condition.  

BOARD FINDINGS:  In the matter of the cervical strain condition and IAW VASRD §4.71a, the panel 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 20161028, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW
               BOARDS 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS
 
Ref:   (a) DoDI 6040.44

      In accordance with reference (a), I have reviewed the cases listed below and approve the recommendations of the PDBR that the following individual’s records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy’s Physical Evaluation Board:

- XXXXXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXXXXX, former USN

	XXXXXXXXXXXXXXXXXX
	Acting