RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2017-04444
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20070426

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Infantryman, medically for “chronic neck pain” with a disability rating of 0%.  

CI CONTENTION:  “My conditions have gotten worse.”  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 - 20070220	VARD - 20080717	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Neck Pain	5237	0%	Herniated Disc C4-C7	5237	10%	20080425	
Recurrent Chronic Headaches	Not Unfitting					
Stress Induced Asthma	Not Unfitting	Asthma	6602	10%	20080425	
COMBINED RATING:  0%	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 sustained blows to the head and neck during combative training in July 2005, and X-rays in December 2005 showed disc protrusion and osteophytes, but surgery was not indicated.  The 29 November 2006 MEB physical therapy (PT) range of motion (ROM) study  recorded active flexion to 41 degrees (normal 45), and (with application of VASRD spine notes 2 and 4) a combined ROM of 285 degrees (normal 340).  The examiner specified that an inclinometer was used for measuring flexion, extension, and lateral flexion, and a goniometer was used for rotation.  There was tenderness present, with no muscle spasm, guarding, or abnormal spinal or gait.  The 8 January 2007 MEB NARSUM examination, 4 months prior to separation, noted complaints of disturbed sleep secondary to neck pain.  The examiner noted no gross abnormalities “other than those related to the decreased range of motion at the cervical spine,” and opined that there was “obvious decreased range of motion secondary to pain.”  There were no ROM measurements, or mention of spasm, guarding, gait, or spinal contour.  At the 25 April 2008 VA Compensation and Pension (C&P) examination, 12 months after separation, physical examination revealed flexion to 45 degrees and a combined ROM of 205 degrees, after repetition.  Gait was normal with no tenderness, and spasm or guarding was not mentioned.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the neck condition 0%, coded 5237 (cervical spine strain), citing no spasms and “292.9 degrees” pain limiting combined active ROM.  The VA rated the neck condition 10%, coded (5237), based on the C&P examination, citing flexion greater than 30 degrees but not greater than 40 degrees; or, combined ROM greater than 170 degrees but not greater than 335 degrees.  Panel members noted that an inclinometer was used for some of the measurements at the PT examination.  However, both left and right rotations with a goniometer showed less than 80 degrees of ROM.  Thus, the panel agreed that a 10% rating, but no higher, was justified for combined ROM, as reported on the PT and VA examinations.  Alternatively, limitation of flexion noted at the VA examination, and tenderness reported on the PT examination also warranted a 10%, but provided no benefit to the CI.  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 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 10% for the neck condition, coded 5237.  

Contended PEB Conditions:  Recurrent Chronic Headaches and Stress Induced Asthma.  The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting.  Neither of the conditions were profiled or implicated in the commander’s statement, and did not fail retention standards.  There was no performance-based evidence from the record that any of the conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions, so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the neck condition, the panel recommends a disability rating of 10%, 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	
Chronic Neck Pain	5237	10%	

The following documentary evidence was considered:

AR20200000689, XXXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXX:

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.