RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXX  	CASE:  PD-2017-04457
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20070508

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Integrated Avionics Systems Journeyman, 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 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 - 20070323	VARD - 20070829	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Neck Pain	5237	10%	Strain, Cervical Spine	5237	0%	20070618	
COMBINED RATING:  10%	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 February 2006 with no history of injury or trauma.  The 30 November 2006 pain management evaluation noted complaints of occasional “spasm and tingling,” some temporary relief from manipulation, and improving range of motion (ROM), and the provider documented normal flexion and mildly reduced extension and bilateral rotation.  At a primary care visit on 11 December 2006, 5 months prior to separation, the CI reported neck pain (rated at 3/10) and stiffness.  On examination, the provider noted no acute distress, and not tenderness or instability.  The cervical spine did not show full ROM and pain was elicited by motion.  Cranial nerves and overall sensory findings were normal.  

During the 20 February 2007 MEB NARSUM examination, 3 months prior to separation, the CI complained of constant neck pain that worsened when turning his head, but denied any radiation to the extremities.  He stated that almost all physical activity, including walking, increased his pain.  Physical examination showed poor posture, and when sitting, he had a posterior pelvic tilt, decreased lordosis, increased kyphosis, rounded shoulders and forward head.  There was tenderness and muscle spasms of the cervical paraspinals, and while upper extremity strength was normal, cervical stabilizers strength was 3/5.  Sensation of the upper extremities was intact to light touch and reflexes were 2+.  Cervical spine ROM showed flexion of 30 degrees (normal 45) with a combined ROM of 235 degrees (normal 340) and painful motion.  

At the 18 June 2007 VA Compensation and Pension (C&P) examination, 1 month after separation, the CI reported constant cervical spine stiffness and pain, without radiation.  The pain was elicited by physical activity, and described as “aching” and occasionally “sharp” with a severity level of 2/10.  He could perform activities of daily living and did not have any incapacitating episodes.  Physical examination revealed tenderness of the entire cervical spine, but no muscle spasms or radiation of pain on movement.  Cervical spine flexion was to 45 degrees and combined ROM was 340 degrees.  After repetitive motion, ROM was not further limited by pain, fatigue, weakness, lack of endurance or incoordination.  Cervical spine X-rays revealed good alignment throughout with disc spaces preserved and vertebral body height maintained.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the neck condition 10%, coded 5237 (cervical strain).  The VA rated the neck condition 0%, coded 5237, based on the C&P examination, citing normal cervical spine ROM, no tenderness, spasm or deformity, and negative X-ray findings.  Panel members noted that although MEB NARSUM recorded ROM measurements which met the threshold for a 20% rating, the C&P examination was more proximate to separation, more detailed, reported ROM performed after repetitive motion, and more consistent with other examination findings.  Therefore, the panel placed greater probative value on the VA examination and agreed that a 10% rating, but no higher, was justified for cervical spine tenderness.  There was neither muscle spasm nor guarding severe enough to result in an abnormal gait or spinal contour, thus the next higher 20% rating was not justified on this basis.  Additionally, 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 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:  

SAF/MRB

Dear XXXXXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-04457.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate.  Accordingly, the Board recommended no rating modification or re-characterization of your separation.

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that modification of your disability rating or characterization of your separation is not warranted.  Accordingly, I accept the recommendation that your application be denied.