RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2017-05678
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060804

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a National Guard E4, Motor Transport Operator, medically separated for “neck pain” with a disability rating of 0%.  

CI CONTENTION:  In addition to the neck and wrist conditions, review requested review of additional conditions not identified by the Medical Evaluation Board (MEB) and/or Physical Evaluation Board (PEB).  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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the 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 - 20060320	VARD - 20070202	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Neck Pain	5243	0%	Herniated Disc, C5-6	5243	10%	20061216	
Left Wrist Stiffness	Not Unfitting	Status Post Left Wrist Fusion	5215	10%	20061216	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  30% 	

ANALYSIS SUMMARY:  

Neck Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s neck condition began in May 2004 after being hit in the head by an unexploded grenade.  In June 2004, X-rays revealed degenerative changes as well as disc space narrowing about multiple neck vertebra, and electro-diagnostic studies were normal.  During the 30 September 2005 MEB examination (recorded on DD Forms 2807-1 and 2808), 10 months prior to separation, the CI reported being in good health, and the examiner documented decreased but unquantified cervical spine range of motion (ROM).  A physical therapy (PT) encounter on 21 December 2005, recorded cervical spine flexion to 40 degrees (normal 45) and a combined ROM of 265 degrees (normal 340), and a follow-up a month later noted cervical flexion to 40 degrees and a combined ROM of 180 degrees.  The 30 January 2006 MEB NARSUM examination, 6 months before separation, noted complaints of continued neck pain aggravated by lateral movements.  Physical findings showed no abnormal spinal contour, tenderness, spasm or guarding.  Motor strength, reflexes, and sensation were normal, and cervical spine ROM was full in all planes of motion.  
At the 16 December 2006 VA Compensation and Pension (C&P) examination, 4 months after separation, the CI reported continued neck pain with occasional flare-ups.  The examiner noted no abnormal spinal contour, tenderness, spasm or guarding, and neck flexion was painful, but normal, with a combined ROM of 210 degrees and no further limitation after repetition.  Peripheral motor strength and reflexes were normal. 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the neck condition 10%, coded 5243 (intervertebral disc syndrome (IVDS)), citing ROM limited by pain.  The VA also rated the neck condition 10%, coded 5243, based on the C&P examination, for cervical spine forward 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 agreed that a 10% rating, but no higher, was justified for limitation of flexion or and/or combined ROM as documented in all examinations.  There was no documentation of IVDS 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 5243.  

Contended PEB Condition:  Left Wrist Fusion.  The panel’s main charge is to assess the fairness of the PEB determination that the contended condition was not unfitting.  Although the contended condition was profiled and failed retention standards, on 23 May 2006, the CI’s orthopedic surgeon noted good grip strength, “excellent” wrist motion and no complaints about the left wrist.  The NARSUM examiner stated the left wrist was “without pain but ha[d] permanent restrictions.  No present medications or further treatment indicated.”  There was no performance-based evidence from the record that the condition 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 rating is recommended.  

BOARD FINDINGS:  In the matter of the neck condition, the panel recommends a disability rating of 10%, coded 5243 IAW VASRD §4.71a.  In the matter of the contended left wrist condition, the panel recommends no change from the PEB determination 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	
Neck Pain	5243	10%	

The following documentary evidence was considered:

AR20200004345

Dear XXXXXXXXXXXXXXXXXX:

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.