RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00011
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070618

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a National Guard E5, Food Service Operations, medically separated for “chronic neck pain with cervical radiculitis” and “chronic pain left shoulder,” rated 10% and 10%, respectively, with a combined disability rating of 20%.

CI CONTENTION:  The CI contended his left shoulder condition.  Additionally the CI contended PTSD which is outside the Board’s scope of review.  The CI’s complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited 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 PEB, but determined to be not unfitting.  Any conditions outside the Board’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.  Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation.  The Board 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, operating under a different set of laws.  The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20070531	VARD - 20070917	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Neck Pain with Cervical Radiculitis, Without Motor Neurologic Abnormality	5299-5237	10%	Intervertebral Disc Syndrome (IVDS) with Degenerative Changes Cervical Spine	5019	10%	20070727	
			Weakness, Left Shoulder, Associated with IVDS, Cervical Spine	8515	10%	20070727	
			Sensory Deficit/Motor Weakness, Right  Shoulder, Associated with IVDS, Cervical Spine	8515	10%	20070727	
Chronic Left Shoulder Pain	5099-5003	10%	Status Post Resection Lateral End, Left Clavicle	5019	10%	20070727	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS: 40%	

ANALYSIS SUMMARY:  

Chronic Neck Pain.  Secondary to a traction type injury involving his left upper extremity in 2005, the CI developed residual chronic neck pain associated with pain, numbness, and tingling of his left hand.  A multi-test radiographic work-up revealed severe multilevel disc disease of the mid and lower cervical spine.  An electro-diagnostic test performed on 30 August 2006 revealed a mild to moderately severe C5-C7 radiculopathy; repeat testing of the same performed on 1 May 2007 remained unchanged with regards to the neck, but also indicated the presence of bilateral carpal tunnel syndrome.  He was permanently profiled in May 2005 for chronic neck pain (one of three diagnoses) and referred to a Medical Evaluation Board (MEB).  At the MEB narrative summary (NARSUM) examination on 12 March 2007 (3 months prior to separation), the CI endorsed the inability to run, jump, or ruck march due to pain in the neck and left arm.  The physical examination revealed tenderness and decreased painful motion of the cervical spine.  His final diagnoses remained chronic neck pain and cervical radiculopathy.  At the VA Compensation and Pension (C&P) examination on 27 July 2007 performed 1 month after separation, the CI reported a constant aching/sharp neck pain which was aggravated by activity and relived by rest.  Additionally, he endorsed neck stiffness and weakness as well as occasional weakness in his left hand.  He could function with medication.  He reported having no incapacitating episodes and no functional impairment had resulted from the condition.  His PE was detailed and normal.  There was no evidence of radiating pain upon cervical movement.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under an analogous 5299-5237 code (lumbosacral strain), citing painful motion and tenderness.  The VA assigned a 10% rating using the 5019 code (bursitis) based on the VA C&P examination 1 month after separation, citing painful motion.  The MEB NARSUM clearly presented a PE proximate to the DOS which met the 10% rating criteria for localized tenderness not resulting in abnormal spinal contour as well as a combined ROM.  Board members agreed the 5237 code was appropriate to the presenting pathology and that there were no other available alternative or analogous coding options which were applicable and or advantageous to the CI’s current 10% rating in accordance with the general rating formula for diseases and injuries of the spine.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB’s adjudication for the neck condition.

The Board also considered if an additional disability rating was justified for peripheral nerve impairment due to a radiculopathy.  Although the CI had subjective radicular symptoms as well as a positive electro-diagnostic test, clinical examinations indicated normal strength, reflexes and the sensory/pain changes did not affect his job.  While the CI may have experienced radiating pain from the cervical spine condition, such symptoms are subsumed under the general spine rating criteria.  There was no evidence in this case that a radiculopathy with associated functional impairments was separately unfitting.  Members deliberated and concluded that there was no evidence in this case that either peripheral motor weakness or sensory impairment existed to any degree that could be described as functionally impairing and therefore, the Board cannot support a recommendation for an additional disability rating on this basis.

Additionally, the VA coded 8515 (incomplete paralysis of the median nerve) citing sensory deficit and motor weakness in both hands, rated 10% each.  Board members first acknowledged and considered the inconsistent correlation between the VA’s diagnoses and code selections and concluded that their selection of 8515 (nerve code) although listed in association with the neck condition was actually caused by the peripheral (at the wrist) compression of the median nerve and diagnosed as carpal tunnel syndrome.  Board members agreed that the peripheral nerve condition in this case was completely separate from the identified neck condition and that the PEB’s analogous coding of 5237 was appropriate to the presenting pathology.  

Chronic Left Shoulder Pain.  Pursuant to the previously described traction type injury of the left upper extremity, the CI developed what appeared to be a traumatic cyst within the left shoulder.  Additionally, radiographs revealed degenerative changes and a ‘questionable’ loose body within the shoulder joint.  His pain persisted despite local injections, and aggressive physical therapy (PT).  On 9 November 2006, he underwent a lateral resection of the left clavicle (collar bone).  Post-operative rehabilitation did improve his pain without complete resolution.  At the MEB examination the CI’s chief compliant remained chronic left shoulder pain.  His PE revealed decreased and painful motion of the left shoulder.  Motor strength of both upper extremities was normal.  The VA examination noted full, but painful motion of the left shoulder as well as tenderness.  There was no edema, effusion, weakness, redness, heat, guarding, or abnormal movement/subluxation.  

The PEB assigned a 10% rating under an analogous 5099-5003 code (degenerative arthritis), citing the USAPDA Pain Policy.  The VA assigned a 10% rating using the 5019 code (bursitis) based on the VA C&P examination 1 month after separation, citing painful or limited motion.  

All Board members agreed that absent compensable shoulder ROM or lack of bony malalignment near the time of Service separation would not rate at an impairment level greater than the PEB’s current 10%.  Board members did consider code 5203 (clavicle impairment) due to the CI’s partial resection for a possible 20% impairment, but that sole rating is distinctly for chronic ‘dislocations’ of the clavicle; which was not present in this case.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3, the Board concluded that there was insufficient cause to recommend a change in the PEB’s adjudication for the chronic left shoulder condition.

BOARD FINDINGS:  In the matter of the neck condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the left shoulder condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration.  The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20131216, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB						

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXXXXX, AR20160006621 (PD201400011)

I have reviewed the enclosed Department of Defense Physical Disability Board of Review (DoD PDBR) recommendation and record of proceedings pertaining to the subject individual.  Under the authority of Title 10, United States Code, section 1554a,   I accept the Board’s recommendation and hereby deny the individual’s application.  
This decision is final.  The individual concerned, counsel (if any), and any Members of Congress who have shown interest in this application have been notified of this decision by mail.

 BY ORDER OF THE SECRETARY OF THE ARMY:

Enclosure

CF: 
(  ) DoD PDBR
(  ) DVA