RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03266
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20071116

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6, Human Resources Specialist, medically separated for “chronic neck pain” with a disability rating of 10%.  

CI CONTENTION:  Review all conditions.  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 - 20070906	VARD - 20080112	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Neck Pain	5241	10%	Residuals, Herniated Nucleus Pulposus (HNP), C5-C6, Status Post Fusion	5235	10%	20070620	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Chronic Neck Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent an anterior discectomy and interbody fusion with cage in June 2005 for a herniated disc at C5-6.  After surgery, radicular arm pain was much improved, but he continued to experience neck and left shoulder pain while rotating his arm, and mild numbness through the left C6 dermatome.  An April 2007 MRI showed postoperative changes at the C5 intervertebral body but no evidence of herniated disk or central stenosis.  The spinal canal was tight at C6, and there was mild right neural foraminal stenosis of C4 and C5 secondary to osteophytes in the adjoining corresponding uncinate process.  

At the 20 June 2007 VA Compensation and Pension (C&P) examination, 5 months before separation, the CI reported constant neck pain at a level of 8/10, with no incapacitating episodes in the previous 12 months.  Physical examination showed a normal gait and posture, and no evidence of radiating pain on movement, muscle spasm, tenderness, or ankylosis of the cervical spine.  He had full range of motion (ROM) with painful right and left rotation.  

The 10 August 2007 MEB NARSUM examination, 3 months prior to separation, noted CI complaints of constant neck pain that increased with turning the neck, bending, long rides, bouncing, and lifting above shoulder level.  Physical examination showed flexion of 30 degrees flexion (normal 45) and combined ROM of 225 (normal 340), with painful motion.  The provider noted tenderness, but did not mention abnormal gait, posture, spasm, or guarding.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the neck condition 10%, coded 5241 (spinal fusion), citing tenderness and ROM limited by pain, with likely application of AR 635-40, B-29.  The VA also rated the neck condition 10%, coded 5235 (vertebral fracture or dislocation), based on the C&P examination, citing painful motion.  Members adjudged that the NARSUM examination, which was closest to separation and aligned with the underlying pathology, carried the highest probative value for rating at separation.  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 this 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 of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 20% for the neck condition, coded 5241.  

BOARD FINDINGS:  In the matter of the chronic neck pain, the panel recommends a disability rating of 20%, coded 5241 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	
Chronic Neck Pain	5241	20%	

The following documentary evidence was considered:

AR20180012276, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear  XXXXXXXXXXXXXXXXXX

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.

Enclosure