RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXXXXXXXX		CASE: PD-2017-03031 BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20061027

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

CI CONTENTION:  No specific contention was made.  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 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 - 20061002	VARD - 20070130	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Cervicalgia	5299-5237	10%	Cervical Spine DDD	5243	10%	20070105	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 10%	

ANALYSIS SUMMARY:

Cervicalgia, with MRI Evidence. According to the service treatment record and MEB narrative summary (NARSUM), the CI’s neck condition began in December 2005 after ruck marching. X- rays showed a normal cervical spine, but an MRI revealed disc bulging at C3-4 with mild central canal narrowing and disc protrusion at C4-5 with cord impingement and central canal stenosis. Electrodiagnostic testing  found  a  mild  cervical  radiculopathy  at  the  left  C6-C7  level.  The  28 August 2006 range of motion (ROM) study of the neck by physical therapy (PT) showed 45 degrees of flexion (normal) and combined ROM of 305 degrees (normal 340) with pain.   The    11 September 2006 MEB NARSUM examination, 1 month prior to separation, noted complaints of near constant pain. Physical examination showed a normal gait, but there was tenderness. During the MEB examination (recorded on DD Forms 2807-1 and 2808), the same day, revealed tenderness and decreased rotation to the right.

At the 5 January 2007 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported moderate and constant neck pain aggravated by lifting and driving. The examiner found tenderness and muscle spasms, but gait and spinal contour were normal.

Cervical spine ROM testing showed normal flexion and combined ROM of 330 degrees. There was no additional limitation with repetitive motion.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the neck condition 10%, analogously coded 5299-5237 (cervical spine strain), citing tenderness and pain-limited ROM. The VA also rated the neck condition 10%, coded 5243 (intervertebral disc syndrome(IVDS)), based on the C&P examination, citing forward flexion of the cervical spine greater than 30 degrees but not greater than 40 degrees.

The panel agreed that a 10% rating, but no higher, was justified for limitation of combined ROM greater than 170 degrees but not greater than 335 degrees. 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 IVDS 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 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. 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:

PD-2017-03031 

[AR NUMBER], XXXXXXXXXXXXXXXXXXXXXXX

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.

PD-2017-03031