RECORD OF PROCEEDINGS

PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-04053
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20060324

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a Reserve E6, Health Care Specialist, medically separated for “chronic neck pain” with a disability rating of 20%.  

CI CONTENTION:  “Army unable to give accurate diagnosis…so gave me option to medically board out.”  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 - 20060221	VARD - 20060720	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Neck Pain	5299-5242	20%	Cervical Spondylosis and DDD C5-6	5242	10%	20060516	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Chronic Neck Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s neck condition began in July 2005 with no specific injury or trauma noted.  The CI declined surgery.  The 24 August 2005 family practice clinic appointment, 7 months prior to separation, noted complaints of muscle spasms and pain in the neck.  Examination revealed tenderness.  An MRI done in September 2005, showed reversal of normal cervical spine lordosis and degenerative disk disease (DDD) at C4-5 and C5-6.  There was benign air attenuation oval-shaped lucency in the left lateral posterior aspect of the C6 vertebral body and mild edema of the C7 vertebral body.  

During the internal medicine appointment on 26 October 2005, 5 months prior to separation, the CI complained of neck pain on both sides and in the trapezius bilaterally.  Examination revealed tense para vertebral muscle, tenderness and decreased cervical range of motion (ROM).  

At the time of the occupational therapy clinic appointment on 27 October 2005, 5 months prior to separation, the CI complained of chronic neck pain causing difficulty lifting heavy objects, overhead work and turning head to look both ways.  The cervical spine ROM study showed pain-limited flexion of 10 degrees (normal 45) and combined ROM of 120 degrees (normal 340).  Physical therapy evaluation on 2 November 2005 documented right sternocleidomastoid and upper trapezius muscle tightness and decreased ROM with flexion of 25 degrees.  

The 10 January 2006 MEB NARSUM examination, 2 months prior to separation, noted complaints of chronic neck pain that would wax and wane with intensity.  Examination showed some paravertebral muscle fullness with decreased ROM.  The cervical spine ROM measurements recorded active flexion to 10 degrees and combined ROM of 120 degrees with “limitation of ROM secondary to pain.”  The examiner noted a normal gait.  At the 23 January 2006 acute care clinic, 2 months prior to separation, the CI complained of chronic neck pain worsening in the 2 days prior to the appointment.  The examiner noted the CI was not healthy appearing and had a cervical soft collar in place.  Neck examination showed tenderness, pain elicited by motion and decreased ROM due to pain.  

At the 16 May 2006 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported severe stiffness, pain and popping during flare-ups and incapacitating episodes as often as 2 times per year.  Physical examination showed both normal posture and gait.  There was no evidence of radiating pain, muscle spasm or tenderness.  Cervical spine ROM testing showed flexion to 45 degrees and combined ROM of 245 degrees, after repetitive motion.  There was painful motion and pain had the major functional impact.  There were no signs of intervertebral disc syndrome with chronic and permanent nerve root involvement.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the neck condition 20%, analogously coded 5242 (degenerative arthritis of the spine), citing reversal of normal cervical spine lordosis with degenerative changes and cervical ROM limited by pain.  The VA rated the neck condition 10%, coded 5242, based on the C&P examination, citing combined ROM of the cervical spine greater than 170 degrees but not greater than 335 degrees.  

The panel majority agreed that a 30% rating was justified for limitation of flexion not greater than 15 degrees as reported on the occupational therapy and MEB NARSUM examinations.  These were the only complete pre-separation ROM measurements in evidence, and the panel used the active ROM measurements in determining the appropriate rating.  The panel noted the limitation of cervical spine motion recorded in the VA C&P examination met the threshold for a 10% rating.  In assigning probative value to these somewhat conflicting examinations, the panel noted the occupational therapy measurements, and those listed on the MEB, were more consistent with outpatient notes and more reflective of the anticipated severity based on the clinical pathology.  The panel majority therefore relied more heavily on those measurements and determined the 30% rating was appropriate. There was no evidence of intervertebral disc syndrome which resulted in incapacitating episodes requiring physician-prescribed bed rest to warrant consideration of rating under that alternate VASRD formula.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel majority recommends a disability rating of 30% for the neck condition, coded 5299-5242.

BOARD FINDINGS:  In the matter of the neck condition, the panel majority recommends a disability rating of 30%, coded 5299-5242 IAW VASRD §4.71a.  The single voter for dissent recommends no change but does not elect to submit a minority opinion.  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; and, that the discharge with severance pay be re-characterized to reflect permanent disability retirement, effective the date of medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Neck Pain 	5299-5242	30%	

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Dear XXXXXXXXXX:

I accept the recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) to re-characterize your separation as a disability retirement with the combined disability rating of 30% effective the date of your medical separation for disability with [severance pay] [Reserve retirement].  Enclosed is a copy of the Board’s recommendation and record of proceedings for your information.

	The re-characterization of your separation as a disability retirement will result in an adjustment to your pay providing retirement pay from the date of your original medical separation [minus the amount of severance pay you were previously paid at separation].
 
	The accepted DoD PDBR recommendation has been forwarded to the Army Physical Disability Agency for required correction of records and then to the U.S. Defense Finance and Accounting Service to make the necessary adjustment to your pay and allowances.  These agencies will provide you with official notification by mail as soon as the directed corrections have been made and will provide information on your retirement benefits.  Due to the large number of cases in process, please be advised that it may be several months before you receive notification that the corrections are completed and pay adjusted.  Inquiry concerning your correction of records should be addressed to the U.S. Army Physical Disability Agency, 
	A copy of this decision has also been provided to the Department of Veterans Affairs