RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	     CASE:  PD-2014-00855
BRANCH OF SERVICE:  Army 		SEPARATION DATE:  20090608

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Unit Supply Specialist, medically separated for “neck pain,” with a disability rating or 20%.  

CI CONTENTION:  “Neck diffusion, couldn’t wear military PPE personal protective equipment to deploy.”  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 -  20090514	VARD - 20100126	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Status Post C4-C-6 ACDF	5241	20%	Intervertebral Disc Degeneration, Status Post Cervical Fusion	5243	20%	20090527	
Normal neurological examination noted	Musculocutaneous Nerve Involvement	8517	10%	20090527	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Status Post C4-C-6 Anterior Cervical Discectomy/Fusion.  The CI was evaluated for left arm and leg numbness and tingling in February 2007.  A head computerized tomography (CT) scan was normal and her physical examination was not consistent with a neurological problem.  She next sought medical attention for a neurological disability on 23 September 2008 when she awoke with neck pain which radiated to the right upper extremity (RUE) and inability to use the right arm.  An examination showed impaired sensation of the RUE and weakness (3/5) of the right hand and arm.  A CT scan showed degenerative changes, especially at the C5-6 level.  She was evacuated from theater and found to have severe spinal cord compression.  On 10 October 2008 she was treated surgically with an anterior discectomy and fusion (ACDF) from C4-6.  Magnetic resonance imaging (MRI) on 18 December 2008, done for new onset LUE weakness, showed that the previously present C4-5 disc was resolved and that fusion was intact.  However, some effacement of the cord at C6 was present on the left.  A repeat CT scan on 26 January 2009 showed mild bilateral neuroforaminal narrowing without comment on nerve root or spinal cord impingement.  The CI was evaluated in orthopedics on 28 January 2009, 4 months prior to separation, for the Medical Evaluation Board (MEB).  She reported residual discomfort of the LUE, but in a non-dermatomal (non-radicular) fashion.  Her neck pain persisted and limited her range-of-motion (ROM).  The scar was well healed, but tender.  The CT examination of the repair was thought to be appropriate given that the surgery had been 3 months previously.  The narrative summary (NARSUM) was dated 30 March 2009.  She reported persistent limitation in ROM, but her neck pain and radiculopathy had resolved.  On examination, the scar remained slightly tender, but the muscles and spine were not tender and axial loading did not cause pain.  The neurological examination was intact.  The ROM was reduced.  At the VA Compensation and Pension (C&P) examination performed on 27 May 2009, 11 days prior to separation, the CI reported a 15-year history of neck pain, but denied incapacitation.  She was unable to accomplish the activities of daily living including brushing her teeth.  On examination, the surgical scar was not tender and did not limit function.  Her posture and gait were normal and spasm was absent.  Painful motion was not present; however, the ROM was limited to the onset of pain.  Motor function and reflexes were normal.  Sensation was reduced for C5 and C6 on the right corresponding to the long thoracic and musculocutaneous peripheral nerves. 

The PEB and VA both rated the neck at 20%, coded 5241 (spinal fusion) and 5243 (intervertebral disc syndrome), respectively.  The Board considered the findings and found no route to a higher rating.  The VA also rated the CI at 10% for musculocutaneous nerve involvement.  The Board noted that the orthopedic examination did not find a radiculopathy.  The NARSUM documented a normal neurological examination and the CI stated that her radiculopathy had resolved.  The C&P examination documented a sensory deficit, but did not record any functional impairment.  The evidence does not support the presence of an unfitting radiculopathy at separation.  The Board concluded therefore that this condition could not be recommended for additional disability rating.  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 adjudication for the neck condition.  

BOARD FINDINGS:  In the matter of the neck condition (status post C4-6 ACDF) 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 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 20140116, 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, AR20160006029 (PD201400855)

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