RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01544
BRANCH OF SERVICE:  army 	SEPARATION DATE:  20051019

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Satellite Communication Systems Operator/Maintainer, medically separated for “neck and shoulder pain” with a disability rating of 10%.

CI CONTENTION:  “Brain trauma and degenerative disk disease prove to be more debilitating in the ‘real world.’”  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 - 20050729	VARD - 20061212	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Neck and Shoulder Pain	5237	10%	Degenerative Changes with Neuroforamina Narrowing secondary to uncovertebral osteophytes C4-5 and C5-6	5242	10%	20060615	
			Bilateral Trapezius Muscle Strain	5024-5301	10%	20060615	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30% 	

ANALYSIS SUMMARY:  

Neck and Shoulder Pain.  The PEB combined the neck and shoulder conditions under a single disability rating, coded 5237 and rated 10%.  This approach by the PEB not uncommonly reflected its judgment that the constellation of conditions was unfitting, and there was no need for separate fitness adjudications.  The panel’s initial charge in this case was therefore directed at determining if combining conditions under a single rating was justified in lieu of separate ratings.  When considering separate ratings, the panel considers each bundled condition to be reasonably justified as separately unfitting unless a preponderance of evidence indicates the condition would not cause the member to be referred into the DES or be found unfit because of physical disability.  When the panel recommends separate fitness recommendations in this circumstance, its recommendations may not produce a lower combined rating than that of the PEB.  The evidence for the neck and shoulder conditions are presented together, with attendant recommendations regarding separate unfitness, and separate rating if indicated.  

According to the service treatment record and MEB narrative summary (NARSUM), the CI’s neck and shoulder conditions began in October 2004 after he was struck in the head by a large piece of satellite equipment (unconscious for 5 minutes).  Cervical spine X-rays showed no evidence of a fracture, but a January 2005 MRI showed degenerative changes with neuroforaminal narrowing secondary to uncovertebral osteophytes at C4-5 and C5-6, with no central canal narrowing.  There were no radiographic studies of the shoulders and no surgical indication at that time.  

At the 1 February 2005 pain management consult, 10 months prior to separation, the CI reported neck pain rated at 8/10 and numbness in his right third and fourth fingers; he denied weakness in his upper extremities.  On examination, the CI was noted to have normal upper extremity motor strength, reflexes and sensation.  There were several trigger points for pain and he had a positive facet loading of the cervical spine.  The 4 February 2005 family practice examination noted upper shoulder and trapezius tenderness, but shoulder range of motion (ROM) was full without any deformities noted.  At the 1 March 2005 primary care clinic visit, the examiner noted the CI had been referred to physical medicine, but that the consult was rejected as there was “nothing further to offer.”  Physical examination revealed limited neck ROM with guarding and cervical paraspinal tenderness.  

The 1 June 2005 commander’s statement specifically implicated the neck condition as limiting the CI’s ability to take the fitness test or participate in unit physical training, but the shoulder conditions were not mentioned.  The 8 June 2005 physical profile indicated that the CI was restricted from performing his military duties due to “chronic neck pain with loss of cervical mobility,” but again, the shoulder conditions were not listed as requiring duty limitations.  

The 8 June 2005 MEB examination (recorded on DD Form 2808), 4 months before separation, documented neck and upper shoulder tenderness with decreased cervical spine ROM due to pain, but no measurements were listed.  The MEB NARSUM examination on the same day, noted CI complaints of constant, dull neck and shoulder pain rated at 6/10.  Aggravating activities included bending, lifting, overhead work, rotating the neck too quickly, wearing protective gear, sitting or standing for prolonged periods, and riding in tactical vehicles.  Cervical ROM measurements after repetition showed 40 degrees of flexion (normal 45) and total combined ROM of 215 degrees (normal 340) with pain in all planes of motion; there were no shoulder ROMs and the focused physical examination was performed by pain management as recorded above.  

At the 15 June 2006 VA Compensation and Pension (C&P) evaluation, 8 months after separation, the CI reported cervical spine pain with stiffness, rated at 4/10, and bilateral upper extremity numbness and tingling to the fingers.  Numbness was precipitated by reaching overhead or moving the neck the wrong way.  He also had shoulder pain, rated at 2-3/10, that was aggravated by reaching for and picking up objects.  Physical examination showed no abnormal cervical contour or evidence of spasm, weakness, or tenderness.  Cervical ROM testing showed flexion of 35 degrees and total combined ROM of 265 degrees with partial limitation due to fatigue, weakness, or lack of endurance following repetition. Although there was bilateral trapezius muscle pain and 4/5 weakness during strength tests, physical examination of the bilateral shoulders showed no objective evidence of painful motion, swelling, instability, weakness or tenderness.  Shoulder ROM testing showed flexion (presumed to be bilateral) of 170 degrees (normal 180) and abduction of 175 degrees (normal 180).
The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the neck and shoulder conditions 10%, coded 5237 (cervical spine strain), citing “the neurological examination was 40 degrees.  The pain is posterior neck and shoulder type.  There are no radicular symptoms.”  The VA rated the neck condition 10% coded 5242 (degenerative disc disease), based on the C&P evaluation, citing forward flexion of the cervical spine greater than 30 degrees but not greater than 40 degrees; or, combined range of motion of the cervical spine greater than 170 degrees but not greater than 335 degrees.  The VA also rated the bilateral trapezius muscle strain 10%, coded 5024-5301 (tenosynovitis causing group I muscle injury), citing slight muscle strain/injury.  

The panel first considered if the neck and shoulder conditions, having been de-coupled from the combined PEB adjudication, remained separately unfitting as established above.  Members noted the CI’s shoulders were not a significant focus of clinical concern with no associated radiographic studies found in the record.  They were not implicated in the commander’s statement or profiled, and there were no physical findings documented by the MEB examiners which would logically be associated with significant shoulder disability.  Additionally, the PEB concluded the shoulder pain did not significantly interference with the performance of duties.  Therefore, the panel concluded that the preponderance of evidence showed the bilateral shoulder condition would not have caused the CI to be referred into the DES or to be found unfit.  The panel agreed that a 10% rating, but no higher, was justified for limitation of cervical flexion greater than 30 degrees but not greater than 40 degrees and/or combined cervical ROM greater than 170 degrees but not greater than 335 degrees, as reported on the MEB NARSUM and VA examinations 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 neck condition.

BOARD FINDINGS:  In the matter of the neck condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the bilateral shoulder condition, the panel agrees that it was not unfitting at the time of separation and cannot recommend it for additional disability rating.  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 20170227, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180005237, 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