RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX 	CASE:  PD-2017-03025
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080115

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Motor Transport Operator, medically separated for “cervical strain” with a disability rating of 10%.   

CI CONTENTION:  “I now have a life-long injury where I am in severe pain every day and have to rely on pain medication (which isn’t strong enough) to function day to day.”  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 – 20071016	VARD - 20080818	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Cervical Strain	5237	10%	Degenerative Disc Disease, Cervical Spine	5237-5010	10%	20080225	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Cervical Strain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s neck condition began in September 2006 while playing football.  An initial MRI revealed a C5/C6 broad-based disc bulge, and during an orthopedic consult on 2 November 2006, the CI reported persistent pain located at the base of the neck with intermittent pain radiating into the right shoulder.  An MRI performed on 15 March 2007 revealed a mildly worsened condition to include additional disc protrusion at C4/C5.

During the 17 July 2007 MEB examination (recorded on DD Forms 2807-1 and 2808), 6 months prior to separation, the physical examination revealed diffuse cervical tenderness on the right side from C4-C7, and normal reflexes and motor strength.  Cervical range of motion (ROM) showed “normal” forward flexion and combined ROM of 280 degrees (normal 340).  The 28 August 2007 MEB NARSUM examination, 5 months before to separation, noted CI complaints of continued neck pain, rated at 5-7/10, with occasional increases to 10/10 with sudden movements.  The examiner recorded tenderness at C4-C6 without muscle spasms, and cited ROM measurements from the MEB examination.  

At the 25 February 2008 VA Compensation and Pension (C&P) examination, 1 month after separation, the CI reported worsening, painful symptoms with poor response to conservative treatment.  Specifically, he had constant daily pain with numbness and tingling extending into the right arm.  However, he denied any incapacitating episodes within the past 12 months.  The physical examination revealed cervical tenderness without spasms, and guarding severe enough to cause abnormal spinal contour with moderate straightening of the normal cervical lordosis.  Cervical spine ROM measurements revealed forward flexion to 30 degrees (normal 45) and combined ROM of 250 degrees, with painful motion.  There was no additional limitation with repetitive motion, and motor strength and reflexes were normal.  There was decreased sensation in the entire right hand with normal pinprick and touch.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the cervical spine condition 10%, coded 5237 (cervical spine strain), citing full motion with some tenderness but no spasms.  The VA also rated the cervical spine condition 10%, but analogously coded 5237-5010 (cervical spine strain-arthritis due to trauma) with no specific evidence cited in the VA rating decision.  Panel members agreed that the limitation of cervical spine motion recorded in the MEB NARSUM examination met the threshold for a 10% rating, whereas the VA ROM findings met the threshold of a 20% rating.  In deliberating the probative value of these examinations, the panel noted the VA examination was closer to separation and more detailed, and thus carried more probative value.  The panel agreed that a 20% rating, but no higher, was justified for limitation of flexion (greater than 15 degrees but not greater than 30 degrees), as reported on the VA examination.  Additionally, guarding associated with abnormal spinal contour was present on the examination.  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 the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 20% for the cervical spine condition, coded 5237.  

BOARD FINDINGS:  In the matter of the cervical spine condition, the panel recommends a disability rating of 20%, coded 5237 IAW VASRD §4.71a.  There are no other conditions within the panel’s scope of review for consideration.  

The panel recommends the CI’s prior determination be modified as follows, effective the date of medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Cervical Strain	5237	20%	

The following documentary evidence was considered:

[AR NUMBER], XXXXXXXXXXXXXXXXXX

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Dear XXXXXXXXXXXXXXXXXXX

The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	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. 

	A copy of this decision has also been provided to the Department of Veterans Affairs. 

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Enclosure