RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2017-04589
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20061123

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a National Guard E4, Combat Engineer, medically separated for “chronic radiating neck pain” with a disability rating of 10%.  

CI CONTENTION:  “Review all of my discharge.”  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 - 20061030	VARD - 20061208	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Radiating Neck Pain	5237	10%	Ruptured Disc in Upper Back C5 and C6	5242	20%	20061025	
			Cervical Radiculopathy into the Upper Left Extremity (Ambidextrous/Major Extremity) Associated with Ruptured Disc in Upper Back C-5 and C-6	8515	10%	20061025	
Mild Right High-Frequency Hearing Loss 	Not Unfitting	No VA Placement	
Hypertension 			
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30% 	

ANALYSIS SUMMARY:  

Chronic Radiating Neck Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s neck pain began in June 2004 after he turned his head suddenly to shoot his weapon during a live fire exercise.  At the neurosurgery clinic on 17 April 2006, 7 months prior to separation, the CI complained of neck pain with intermittent left arm pain/numbness.  On physical examination, a foraminal compression test did not cause pain to radiate to the right or left arm with the head rotated to the right or to the left.  The examiner noted intact sensory findings, and normal motor strength.  Gait and stance were also normal, and the CI could heel and toe walk without difficulty.

The 25 July 2007 physical therapy evaluation for the MEB, 4 months before separation, 3575117documented “cervical flexion full AROM” (normal 45) and combined ROM of 285 degrees (normal 340) after repetition and using a goniometer.  An EMG performed the same day was normal.  The MEB NARSUM examination two days later, noted CI complaints of persistent neck pain.  Physical examination showed tenderness without spasm over the lower paracervical spine muscles.  Bilateral upper extremity ROM was full, strength and deep tendon reflexes were normal, and sensation was intact.  Waddell signs were positive for 1/5 pain with axial loading.  The examiner noted that a spine MRI in July 2006 showed multilevel degenerative disc disease (DDD) with severe neuroforaminal narrowing at C4 through C-7 along with moderate central canal stenosis.  Cervical spine X-rays confirmed multilevel degenerative changes with narrowing of the C5-7 disc spaces and neuroforaminal narrowing at C3-7.  

At the 25 October 2006 VA Compensation and Pension (C&P) examination, 1 month before separation, the CI reported daily neck pain, marked stiffness, and burning in his left upper extremity.  The examiner noted that with repetitive flexion and extension, the CI was limited primarily by stiffness and secondarily by pain.  There was no obvious atrophy, and upper extremity motor strength was normal and symmetrical with “grip strength, flexion/extension at the wrist and flexion/extension at the elbow.”  Physical examination showed goniometrically measured flexion of 45 degrees and combined ROM of 125 degrees.  The sensory examination showed diminished two-point discrimination to 5 mm in the fourth and fifth digits of the left hand.  Two-point discrimination was normal in the right hand.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the neck condition 10%, coded 5237 (cervical strain), citing imaging of multilevel DDD with no herniation, normal electro-diagnostic studies, and full ROM without spasm but some paraspinal muscle tenderness.  The VA rated the neck condition 20%, coded 5242 (degenerative arthritis of the spine), based on the C&P examination, citing cervical combined ROM not greater than 170 degrees.  The VA also rated the CI for cervical radiculopathy into the upper left extremity at 10%, coded 8515 (paralysis of median nerve), citing mild, incomplete paralysis of hand movements.  Panel members agreed that a 20% rating, but no higher, was justified for limitation of combined ROM not greater than 170 degrees, as reported on the VA examination most proximate to separation.  The panel next considered if additional disability rating was justified for peripheral nerve impairment due to radiculopathy.  Although the CI reported intermittent left hand numbness, electro-diagnostic studies showed no evidence of neuropathy or radiculopathy, and the MEB NARSUM, VA and neurological examinations indicated normal strength, reflexes and no atrophy.  The VA sensory examination showed diminished two-point discrimination to 5 mm in the fourth and fifth digits of the left hand.  The presence of functional impairment with a direct impact on fitness is the key determinant in the panel’s decision to recommend any condition for rating as additionally unfitting.  While the CI may have suffered additional pain from the nerve involvement, this is subsumed under the general spine rating criteria, which specifically states “with or without symptoms such as pain (whether or not it radiates).”  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 20% for the neck condition, coded 5237.  

Contended PEB Conditions:  Mild Right High-Frequency Hearing Loss and Hypertension.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  Only the hearing loss was profiled (H2), and neither condition was implicated in the commander’s statement or failed retention standards.  There was no performance-based evidence from the record that 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 the contended condition, so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the neck condition, the panel recommends a disability rating of 20%, coded 5237 IAW VASRD §4.17a.  In the matter of the contended mild right high-frequency hearing loss and hypertension, the panel recommends no change from the PEB determinations as not unfitting.  

The panel recommends the CI’s prior determination be modified as follows, effective the date of medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Radiating Neck Pain	5237	20%	

The following documentary evidence was considered:

AR20190007326, XXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXX:

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 and the counsel you listed on your application, XXXXXXXXXXXXXXX, XXXXXXXXXXXXXXXXXXXXXXXXXX.