RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01133
BRANCH OF SERVICE:  army 	SEPARATION DATE:  20060521

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Chemical Operations Specialist, medically separated for a “neck injury” with a disability rating of 10%.

CI CONTENTION:  The CI made no specific contention.  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 - 20060209	VARD - 20070530	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Neck Injury	5241	10%	Status Post Posterior C1-C2 Fusion	5241	20%	20061011	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  50% 	

ANALYSIS SUMMARY:  

Neck Injury.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s neck injury occurred in October 2001 when she was hit on the side of the head by a medicine ball during physical training, with a brief loss of consciousness.  Multiple cervical spine X-rays were normal, but flexion–extension films showed ligamentous laxity at C1-C2 (atlantoaxial joint) and the CI underwent cervical spine surgery with C1-C2 fusion in December 2003.  Following the surgery, her neck pain continued.  Cervical X-rays showed wire circling C1-C2 and metallic wire projecting behind C3.  According to neurosurgery, imaging studies showed incomplete union or fibrous union of the cervical fusion.  Revision surgery was discussed, but given the risks, the CI declined further surgical intervention.  At a 15 March 2003 neurosurgery follow-up, the CI reported doing well with occasional neck pain.  She had regained “much” neck mobility.  The neurological examination was normal.  Flexion and extension films showed no significant instability.  The neurosurgeon recommended a P2 profile if her condition remained stable for 2 months.  

During the troop medical clinic appointment on 24 August 2005, 9 months prior to separation, the CI reported neck pain.  On physical examination, there was tenderness over the left lateral cervical spine area.  “Rolling head clockwise or counter clock wise finds a pain stop point when skull is rotated to the left, she must lift her skull to near upright point past ‘stop’ point and then ‘go around’ stop point, then continue with rolling motion.”  She had normal strength and sensation in her upper extremities and her cervical spine had a normal appearance.  No P2 profile was provided because the CI was unable to fire a weapon, hyperextend her C-spine, ruck, dig a fighting position, or perform 3-5 second rushes.  

During the 31 October 2005 MEB examination (recorded on DD Forms 2807-1 and 2808), 7 months prior to separation, the CI reported “ongoing neck and back pain from injury.”  Physical examination showed full active range of motion (ROM) of the neck with 4/5 muscle strength.  The 1 December 2005 MEB NARSUM examination, 6 months prior to separation, noted complaints of 6/10 neck pain described as “a dull ache with occasional sharp pangs of pain from her upper cervical region.”  She noted pain with light activities such as vacuuming or cleaning her house.  She complained of occasional paresthesias down her left arm that occurred a few times each month and were associated with flares in her neck pain.  She was able to exercise on the stationary bike and elliptical and was also able to do some light weight lifting (maximum 10-25 pounds).  Physical examination showed a normal gait, but she was noted to hold her head rigidly.  There was tenderness of the cervical muscles, without spasm.  The cervical ROM study showed a flexion of 45 degrees (normal 45) and combined ROM of 190 degrees (normal 340), with pain in most planes of motion.  Motor and neurological examinations of the upper extremities were normal, but the CI’s neck strength was 4+/5 due to discomfort.  

At the 11 October 2006 VA Compensation and Pension (C&P) examination, 5 months after separation, the CI reported daily 6/10 neck pain that radiated to her shoulders (left greater than right) associated with spasm, left upper extremity tingling, and limited ROM.  She reported weekly flare-ups of 9/10 neck pain that were activity related and lasted 5-6 hours.  Her neck pain interfered with driving (due to limited field of vision).  Physical examination showed a normal gait with guarded posture.  Neck ROM testing showed flexion of 15 degrees and combined ROM of 210 degrees with pain in all planes of motion.  There was no additional limitation of motion with repetition.  Motor strength was normal for all muscle groups with intact sensation and reflexes.  Cervical spine X-rays showed a broken wire overlying the intervertebral disc at C3-4.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the neck condition 10%, coded 5241 (spinal fusion), citing no spasm or tenderness to palpation with combined ROM of 190 degrees.  The VA rated the neck condition 20%, also coded 5241, based on the C&P examination, citing painful motion of the cervical spine with limited flexion to 30 degrees (error-exam measurement was cervical flexion 15 degrees).  

The limitation of cervical spine flexion at the MEB examination supported the 10% rating as adjudicated by the PEB.  The cervical flexion at the VA C&P examination 5 months after separation was much worse and supported a 30% rating.  The panel noted that the combined cervical ROMs from both examinations were roughly equal and both supported the 10% PEB rating.  The panel majority could find no intervening event or circumstance that would account for the severe reduction in flexion.  The cervical X-rays at the VA examination noted a “broken wire” overlying the posterior aspect of C3-4.  This may have reflected hardware failure since separation, although wire posterior to C3 was noted on post-operative X-rays before separation as well and this may not have in fact been “broken” wire.  In any case, there was no evidence that the CI’s neck condition resulted in such severe limitation of neck flexion prior to separation.  Therefore, the panel majority placed greater probative value on the MEB examination.  The panel agreed that a 10% rating, but no higher, was justified for normal flexion and limitation of combined ROM greater than 170 degrees but not greater than 335 degrees noted at the MEB NARSUM examination.  There was no muscle spasm or guarding severe enough to result in an abnormal 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 neck condition.

BOARD FINDINGS:  In the matter of the neck condition and IAW VASRD §4.71a, the panel majority recommends no change in the PEB adjudication.  The single voter for dissent recommends modification to 20% and did not elect to submit a minority opinion.  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 20170222, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180004927, 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