RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01955
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080605

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty O3, Multifunctional Logistician, medically separated for “chronic neck pain” with a disability rating of 20%.  

CI CONTENTION:  “Radiculopathy, right upper extremity was worse than diagnosed during the PEB and cervicalgia was not diagnosed during the PEB.”  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 - 20080306	VARD - 20080815	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Neck Pain…	5299-5243	20%	Cervicalgia	5237	0%	20080521	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Chronic Neck Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s neck condition began in January 2005 after her car was rear-ended by a light medium tactical vehicle.  In addition to neck pain, the CI complained of radicular symptoms in the right upper extremity.  An electrodiagnostic study (EMG) in October 2007 was normal.  MRI on 4 November 2007, 7 months prior to separation, revealed there was normal anatomic alignment of the vertebral bodies without evidence of subluxation.  The vertebral body and intervertebral disc heights were well maintained. There was no evidence of herniated disc.  The spinal canal was widely patent and the neural foramen demonstrated no evidence of narrowing.  

The 28 November 2007 MEB NARSUM examination, 6 months prior to separation, noted complaints of neck pain.  Physical examination showed there was minimal tenderness over the lower cervical spine.  There was decreased sensation in the right medial arm and right forearm medially and over the first and second fingers.  There was no muscle atrophy and no muscular weakness.  The cervical spine range of motion (ROM) measurements performed by physical therapy on 11 December 2007, 6 months prior to separation, showed flexion was 15 degrees (normal 45) and combined ROM was 180 degrees (normal 340) after repetitive motion.  A goniometer was used for measurements and painful motion was noted by the examiner.  

At the 21 May 2008 VA Compensation and Pension (C&P) evaluation, one month before separation, the CI reported intermittent neck pain, occurring three times a day, with a severity of 10/10.  Her symptoms were reported as stiffness, weakness and numbness.  Physical examination of the cervical spine showed no evidence of pain on movement, muscle spasm or tenderness.  ROM showed flexion of 45 degrees and combined ROM of 340 degrees.  X-rays on 29 May 2008, one month before separation, showed mild multilevel anterolisthesis, with flexion and mild multilevel retrolisthesis with extension.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the neck condition 20%, analogously coded 5243 (intervertebral disc syndrome [IVDS]), citing that ROM was decreased secondary to pain to 18 degrees and there was tenderness of the lower cervical spine.  The VA rated the neck condition 0%, coded 5237 (lumbosacral or cervical strain), based on the C&P examination, citing cervical spine X-rays were normal and ROM was full and without pain.  

The panel agreed that the C&P examination was the most proximate to separation, thus carrying the most probative value.  Panel members thus concluded there was no evidence to support a rating higher than that adjudicated by the PEB.  There was no documentation of IVDS with incapacitating episodes which would provide for a higher rating under that formula.  

The panel noted that the PEB explicitly adjudicated radiculopathy as not independently ratable, citing a normal EMG however the CI contended radiculopathy.  Although the NARSUM examination documented decreased sensation in the right upper extremity and over the first and second fingers, the C&P examination revealed normal sensory and motor function of the upper extremities.  The EMG of the right arm was normal.  Overall, the evidence proximate to separation revealed no objective findings of radiculopathy that would impact duty performance.  While the CI may have suffered additional pain from the nerve involvement, this is subsumed under the general spine rating criteria, which specifically states “with or without symptoms such as pain (whether or not it radiates).”  Therefore the critical decision is whether or not there was a significant motor weakness which would impact military occupation-specific activities.  There was no evidence in this case that motor weakness existed to any degree that could be described as functionally impairing.  The panel therefore concluded that an additional disability rating was not justified on this basis.  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 neck condition.  

BOARD FINDINGS:  In the matter of the neck condition and IAW VASRD §4.71a, the panel unanimously 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 20170225, w/atchs  
Exhibit B.  Service Treatment Record  
Exhibit C.  Department of Veterans Affairs Record  

AR20180010647, 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