RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-04714
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070801

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty, E4, Medical Laboratory 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 – 20070530	VARD - 20071207	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Neck Pain	5237	10%	Cervicalgia 	5237-5243	20%	20070904	
Low Back Pain	Not Unfitting 	Lumbosacral Strain 	5237-5014	10%	20070904	
Pelvis Stress Fracture with Right Hip, Knee and Ankle Pain	Not Unfitting	Right/Left Hip Pain 	5010-5252	20%	20070904	
		Right/Left Knee Retropatellar Pain Syndrome 	5099-5014	0%	20070904	
		Left Ankle Pain	5271	NSC	20070904	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Chronic Neck Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s neck condition began in December 2004 after a motor vehicle accident (MVA).  Radiographic studies showed a disc herniation at C5-6 with no significant nerve compression and a disc bulge at C4-5 without nerve compression.  The 5 October 2006 premier orthopedic evaluation, 10 months prior to separation, noted complaints of neck pain extending to the shoulders with some tingling in the left arm.  Physical examination revealed a normal gait and coordination.  She moved easily in the examination room without difficulty.  There was tenderness.  Upper extremity muscle strength, reflexes and sensation were normal.  The February 2007 electrodiagnostic studies showed no evidence of upper extremity neuropathy, radiculopathy or brachio-plexopathy.  The April 2007 MRI showed the C5-6 lesion was “perhaps” slightly decreased in caliber since the prior MRI. 

During the 7 May 2007 family practice clinic, 3 months prior to separation.  Physical examination revealed a normal appearing cervical spine, but there was tenderness.  Neurological system was normal.  At the 9 May 2007 MEB NARSUM examination, 3 months prior to separation, the CI reported that neck pain limited MOS performance because she was unable to do any plating of samples and could not work at a microscope for any prolonged period of time.  She also had difficulty drawing blood.  Physical examination showed tenderness, but no spasm.  The ROM study showed full flexion, extension, right and left lateral rotation and right and left lateral side bending.  The 7 June 2007 chiropractic memorandum, 2 months prior to separation, noted spasm in the neck and back at every encounter.  The 12 June 2007 family medicine clinic ROM study, 2 months prior to separation, showed cervical flexion of 35 degrees (normal 45) and combined ROM of 260 degrees (normal 340).  

At the 4 September 2007 VA Compensation and Pension (C&P) examination, 1 month after separation, the CI reported chronic neck pain.  Physical examination showed normal gait, motor strength and reflexes.  The ROM study showed flexion of 45 degrees and combined ROM of 340 degrees with pain.  There was no change in active or passive ROM after repetition.  The VA C&P examiner noted “plain films done in March of 2005 of the cervical spine showed loss of normal cervical lordosis with mild kyphosis centered at C-5.”  The primary document was not part of the case file and was more than 2 years prior to separation.  The examiner also referenced a CT scan from July 2006, which showed “straightening of the cervical lordosis.”   The 7 May 2007 family practice clinic evaluation revealed a normal appearing cervical spine.  The MEB examination overall was unremarkable, but spinal tenderness was noted.  There was no cervical muscle spasm.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the neck condition 10%, analogously coded 5237 (cervical strain).  The VA rated the neck condition 20%, dual coded 5237-5243 (cervical strain-intervertebral disc syndrome), based on the C&P examination, citing muscle spasm severe enough to result in an abnormal spinal contour such as scoliosis, reversed lordosis or abnormal kyphosis.  The VA examiner noted “plain films done in March of 2005 of the cervical spine showed loss of normal cervical lordosis with mild kyphosis centered at C-5,” but the primary document was not part of the case file and was more than 2 years prior to separation.  However, the examiner also referred to a CT scan from July 2006, which showed “straightening of the cervical lordosis.”  The chiropractic memorandum reported spasm on “every encounter” with decreased ROM.  The panel agreed that a 20% rating, but no higher, was justified for muscle spasm or guarding severe enough to result in an abnormal spinal contour.  After due deliberation, considering the totality of the evidence and mindful of VASRD §4.3 (reasonable doubt) and VASRD 4.7 (higher of two evaluations), the panel recommends a disability rating of 20% for the neck condition, coded 5237.  

Contended PEB Conditions:  Low Back Pain and Pelvis Stress Fracture with Right Hip, Knee and Ankle Pain.  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, implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that either 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 either of the contended conditions, so no additional disability ratings are recommended.  
BOARD FINDINGS:  In the matter of the neck condition, the panel majority recommends a disability rating of 20%, coded 5237 IAW VASRD §4.71a.  The single voter for dissent recommends no change but does not elect to submit a minority opinion.  In the matter of the contended low back pain and pelvis stress fracture with right hip, knee and ankle pain, the panel recommends no change from the PEB determinations as not unfitting.  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	20%	

The following documentary evidence was considered:

 [AR NUMBER], XXXXXXXXXX

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Dear XXXXXXXXXX:

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