RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00939
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20061013

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Automated Logistical Specialist, medically separated for “chronic neck pain, status post (S/P) C6-7 discectomy and fusion” with a disability rating of 10%.  

CI CONTENTION:  His neck continues to affect his activities of daily life.  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 Medical Evaluation Board (MEB), but determined by the PEB 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.  The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence relevant to application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards for 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, which operates 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 disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20060914	VARD - 20070425	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Neck Pain, S/P C6-7 Discectomy and Fusion	5241	10%	Degenerative Disc Disease (DDD) of the Cervical Spine, S/P Herniated Nucleus Pulposus …	5299-5241	10%	20061214	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Chronic Neck Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s neck condition began in March 2004 while deployed.  The CI denied any specific injury or trauma.  An MRI done on 30 November 2005 showed severe disc bulge with moderate vertebral canal stenosis C6-7 along with DDD and degenerative joint disease throughout his cervical spine.  The CI stated that upon redeployment, his pain was constant and aggravated by lying down, rotating his head to the left, and wearing his personal protective equipment.  On 22 March 2006 he underwent an anterior discectomy and fusion (ACDF) C6-7.  He continued to have pain extending down between his shoulder blades following his surgery. A post-operative MRI revealed no herniated discs above or below his fusion.  

The cervical range of motion (ROM) measurements measured in degrees by physical therapy on 29 June 2006, approximately 3 months prior to separation, showed flexion of 30 (normal 45), extension 20 degrees (normal 45), left lateral flexion 20 and right lateral flexion 30 (normal 45 each), left rotation 45 (normal 80) and right rotation 35 (normal 80).  His combined cervical ROM was 180 degrees (normal 340); there was pain on all measurements.  

The 24 August 2006 MEB NARSUM examination, approximately 2 months prior to separation and 5 months after surgery, noted complaints of continued chronic neck pain.  The CI was unable to fulfill the duties required of his military occupational specialty due to his pain.  At the physical examination the CI was in no acute distress.  There was some paraspinal muscle spasm and tenderness in his posterior neck and between his shoulder blades.  Muscle strength testing was 5/5 throughout and sensation was intact to light touch.  His deep tendon reflexes were normal.  Neither the gait nor spinal contour were recorded.  

At the 14 December 2006 VA Compensation and Pension (C&P) examination, 2 months after separation and 9 months after surgery, the CI reported continued neck pain and numbness and tingling in the index and middle fingers of his right hand.  His right hand numbness was more evident when holding his right arm up over his head or in a free position when holding a steering wheel or a cup of coffee.  He reported no flare-ups that required bed rest ordered by a physician nor any incapacitating episodes and he reported no lost time from work from his neck condition.  The physical examination showed his cervical ROM measured in degrees as flexion 40, extension 30, left rotation 40, right rotation 55, right and left lateral flexion 30, and a combined ROM of 225.  He had pain and discomfort with all measurements.  Motor and sensory examination of his upper extremities was normal.  His reflexes were normal and he had no changes with repetition.  The gait and posture were normal.  There was discomfort with movement, but painful motion was absent.  The neurological examination was normal.  Neither tenderness nor spasm were recorded.  

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 tenderness and pain-limited motion.  The VA also rated the neck pain condition 10%, coded analogously 5299-5241 (spinal fusion), based on the C&P examination, citing limitation of motion.  

Both the PEB and VA examinations were equally proximate to separation.  The VA examination was 4 months further removed from surgery (and attendant immobilization) and determined to be more probative for rating the permanent impairment at separation.  The panel noted that the PEB ROM values supported a 20% rating, but were at the limit between 10% and 20%.  It considered §4.7 (higher of two ratings), but observed that this also relied on the probative value of the examination.  After due deliberation, considering all 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 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 20170207, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180005213, 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