[AR Number], XXXXXXXXXX 

XXXXXXXXXX
XXXXXXXXXX
XXXXXXXXXX

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.

RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-05733
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070314

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a National Guard E5, UH-60 Helicopter Repairman, medically separated for “chronic neck pain, status post C4-6 fusion with a disability rating of 0%.  

CI CONTENTION:  “Should be changed because there was no percentage at all for injuries and illness incurred in LOD.”  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 - 20070124	VARD - 20080111  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Neck Pain, Status Post C4-6 Fusion	5241	0%	Cervical Disc Disease, Status Post Fusion C4-6	5010-5241	20%	20070602	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  50% 	

ANALYSIS SUMMARY:  

Chronic Neck Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI suffered a neck injury in April 2005 when a large glass panel came loose from a section of a garage door and fell onto his head.  He sustained a cut to his forehead, but no loss of consciousness, and his neck was noted to be supple and non-tender.  He subsequently developed neck pain, and an MRI on 25 May 2005 showed degenerative joint and disc disease (DJD and DDD).  The CI’s pain persisted and he reported radiation down the left arm.  Electrodiagnostic testing on 29 July 2006 did not show evidence of a radiculopathy, and a CT scan the same day showed multi-level DJD and DDD.  He was treated with physical therapy without resolution of his symptoms.  An MRI on 16 November 2005 again showed DJD and DDD with nerve root impingement, and he was referred to neurosurgery on 20 February 2006.  Repeat electrodiagnostic studies did not show a radiculopathy.  Due to his persistent pain, the CI underwent anterior cervical disk fusion at C4 through C6 on 26 July 2006.  Although the surgery was technically successful, the CI’s pain persisted.  

The 11 October 2006 MEB NARSUM examination, 5 months prior to separation, noted complaints of constant neck pain, aggravated by activity and relieved by medications, a brace, and rest.  Physical examination showed a normal gait and stance, and no paravertebral muscle spasms or tenderness.  Cervical spine range of motion (ROM) measurements performed by occupational therapy on 17 October 2006, showed flexion of 40 degrees (normal 45) and combined ROM of 185 degrees (normal 340), limited by pain.  Neurological findings were normal.  During the 23 October 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), the examiner noted a marked decrease on ROM (not quantified) and decreased left arm strength.  

During a new patient evaluation at the VA on 17 May 2007, the CI was noted to have “decent” ROM of the neck.  At the 2 June 2007 VA Compensation and Pension (C&P) examination, 3 months after separation, the CI reported daily sharp, aching, constant back pain back that was progressively worsening, but denied incapacitation.  Physical examination showed a normal gait and spinal curvature with no spasm, guarding, or tenderness.  Cervical spine ROM measurements showed flexion of 30 degrees and combined ROM of 290 degrees, limited by pain.  There was no additional limitation with repetition.  Spine X-rays showed expected post-operative findings.  In physical medicine on 1 October 2007, the CI had full, active neck ROM.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the neck condition 0%, coded 5241 (spinal fusion), citing ROM limited by pain, with likely application of the US Army Physical Disability Agency pain policy.  The VA rated the neck condition 20%, dual coded 5010-5241 (traumatic arthritis-spinal fusion), based on the C&P examination, citing forward flexion limited to 30 degrees.  The panel noted that the VA examination was an outlier from the majority of examinations and that examinations before and after it had shown normal or near normal flexion.  The probative value of this examination is therefore reduced despite its proximity to separation.  The panel agreed that a 10% rating, but no higher, was justified for limitation of flexion (greater than 30 degrees but not greater than 40 degrees) and combined ROM (greater than 170 degrees but not greater than 335 degrees), as reported on the MEB NARSUM examination and consistent with the VA post-separation clinical visits.  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.  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 5241.  

BOARD FINDINGS:  In the matter of the neck condition, the panel recommends a disability rating of 10%, coded 5241 IAW VASRD §4.71.  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, Status Post C4-6 Fusion	5241	10%