RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01637
BRANCH OF SERVICE:  AIR FORCE 	SEPARATION DATE:  20080416

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty  E5, Flight Engineer Craftsman, medically separated for “refractory cervicalgia” with a disability rating of 10%.  

CI CONTENTION:  “The PDBR did not look at all findings the VA did 70% rating.”  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 - 20080219	VARD - 20081205	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Refractory Cervicalgia	5237	10%	Cervical Foraminal Stenosis 	5243-5242	10%	20080924	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:  

Refractory Cervicalgia.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s neck condition began in March 2007.  The CI reported numbness in the small fingers bilaterally, aggravated by working overhead.  An MRI on 29 March 2007, 13 months before separation, showed moderate C3-4 foraminal stenosis on the right due to bony spur and/or a disc herniation.  Electrodiagnostic studies on 10 April 2007 showed mild to moderate bilateral carpal tunnel syndrome (CTS) without evidence of ulnar neuropathy or radiculopathy.  The orthopedic follow-up on 10 April 2007 indicated the CI did not wish to proceed with carpal tunnel release at the time due to possible loss of grip strength after surgery.  At an 18 April 2007 flight medicine visit the CI reported neck pain and wrist pain.  At the 24 May 2007 neurosurgery evaluation the CI reported a 2 to 3 year history of posterior upper neck pain and bilateral shoulder pain and history of bilateral CTS, with equal symptoms bilaterally.  Physical examination showed the CI was neurologically intact with no motor deficit.  The neurosurgeon noted that the MRI showed a small disc protrusion at C3-C4 on the right, which did not explain all the CI’s symptoms.  Therefore, it was felt surgery for the C3-C4 disc would not benefit him and his symptoms might be soft tissue related.  A second orthopedic opinion was obtained for evaluation of the bilateral shoulder pain, and the specialist thought the CI’s pain was related to the C3-C4 foraminal narrowing and recommended oral steroids, with possible injections if beneficial as well as continued physical therapy.  

The 11 December 2007 MEB NARSUM examination, 4 months prior to separation, noted complaints of “incapacitating bilateral neck pain for the past nine months.”  The CI reported incapacitating neck pain from wearing his flight helmet or night vision goggles.  Physical examination showed multiple tender points along the lateral and posterior neck, no midline bony tenderness, and no gross deformities.  Neck range of motion (ROM) measurements showed that the CI could touch his chin to his chest (45 degrees, normal) without pain and combined ROM was 310 degrees (normal 340), with discomfort.  

At the time of a physical therapy clinic appointment on 14 December 2007, 4 months prior to separation, the CI reported improving pain symptoms, with only mild soreness 1 day in the past week.  He started working out on his own with less pain.  Physical examination showed ROM of forward flexion of 45 degrees and a combined ROM of 265 degrees.  ROM testing did not cause any sharp pain.  

At the 24 September 2008 VA Compensation and Pension (C&P) examination, 5 months after separation, the CI reported “that he developed neck pain in approximately 2002” and denied a history of trauma to the neck.  He denied flare-ups, but pain waxed and waned.  He reported missing several days of work in the service.  He had a home traction unit which was helpful.  He was taking narcotic pain medication daily with some relief and was able to perform routine daily activities.  Physical examination showed normal cervical spine alignment, with diffuse tenderness of the cervical spine and bilateral paraspinous muscles.  There was normal strength, sensation, and reflexes in the upper extremities.  Neck ROM measurements after ten repetitions showed normal forward flexion and a combined ROM of 255 degrees.  Pain was noted throughout the ROM measurements. 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the neck condition 10%, coded 5237 (cervical spine strain).  The VA also rated the neck condition 10%, coded 5242-5243 (degenerative arthritis of the spine-intervertebral disc syndrome), based on the C&P examination, citing the criteria for rating diseases and injuries of the spine.  

The panel agreed that a 10% rating, but no higher, was justified for combined ROM (greater than 170 degrees but not greater than 335 degrees) as reported on the PT, MEB NARSUM, and VA examinations with painful motion and tenderness documented at the MEB NARSUM and VA examinations.  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 evidence of incapacitating episodes requiring physician-prescribed bed rest in the 12 months before separation to warrant consideration of rating under the alternate VASRD formula for intervertebral disc syndrome.  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 refractory cervicalgia condition.

BOARD FINDINGS:  In the matter of the refractory cervicalgia 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 20170227, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD  20762

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-01637.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate.  Accordingly, the Board recommended no re-characterization or modification of your separation.

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  Accordingly, I accept their recommendation that your application be denied.

						Sincerely,

								XXXXXXXXXXXXXXXXXX
								Director
								Air Force Review Boards Agency

Attachment:
Record of Proceedings