RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00901
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20091216

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E4, Construction Equipment Operator, medically separated for “degenerative arthritis of the cervical spine,” with a disability rating of 10%.

CI CONTENTION:  The CI contends he was not evaluated for his stomach, left shoulder, and bone spur conditions.  The applicant’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 - 20090911	VARD - 20100104	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Degenerative Arthritis of the Cervical Spine	5242	10%	Cervical Spine Degenerative Arthritis	5242	10%	20091029	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Degenerative Arthritis of the Cervical Spine.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s degenerative arthritis of the cervical spine condition began in July 2006 after working out in the gym as part of physical fitness training.  He reported neck and posterior left shoulder pain.  Cervical spine magnetic resonance imaging (MRI) performed 9 May 2007 showed mild degenerative disc disease and spinal arthritis.  At an orthopedic evaluation on 13 June 2007 the CI reported neck and bilateral upper back pain to the shoulders and the examiner noted that evaluation by physical medicine had diagnosed cervical radiculitis.  The CI received multiple types of injections for the neck condition over the course of treatment, including epidural steroid injections, without significant improvement.  A repeat MRI performed on 27 May 2009 noted DDD and spinal arthritis without significant spinal canal stenosis.  The CI was evaluated by neurosurgery, but did not wish to pursue surgical options and conservative treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “cervicalgia” and “osteophyte complex formation of the cervical spine” for PEB adjudication.

At the MEB NARSUM examination (recorded on DD Forms 2807 and 2808) dated 29 July 2009, 5 months prior to separation, the CI reported constant neck and upper back pain that occurred daily, rated 6/10 scale in intensity.  He had flare-ups of his neck pain rising to 8/10 intensity twice a month, lasting 2 days.  His pain was aggravated by lifting, working overhead, and sneezing and relieved by medications and a transcutaneous electrical stimulation (TENS) unit The CI reported he had not missed any work in the past six months  Physical exam showed normal cervical and thoracic spinal contours, without muscle spasm.  The CI had tenderness to palpation of the paraspinal neck muscles without radicular signs.  Cervical spine ROM after repetition was forward flexion of 45 degrees (normal 45 degrees) and combined ROM of 335 (normal 340 degrees) and pain at all end ROM was noted.  Upper extremity strength, sensation, and reflexes were normal.

At the VA Compensation and Pension (C&P) examination on 29 October 2009, performed 2 months before separation, the CI reported constant localized neck pain described as moderate.  The pain was aggravated by physical activity.  During flare-ups he had difficulty lifting, limited range of motion, and could not wear military equipment.  The pain was relieved by chiropractic therapy, physical therapy, and medications.  The examiner noted there were no periods of incapacitation during the past 12 months.  Physical examination showed normal gait and posture.  There was no radiating pain with movement, or neck guarding, tenderness, or weakness.  There was muscle spasm noted.  Cervical spine ROM after repetition was forward flexion of 40 degrees and combined ROM of 305 degrees, limited by pain and there was no additional loss of ROM with repetition.  Upper extremity strength, sensation, and reflexes were normal.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the degenerative arthritis of the cervical spine condition 10% coded 5242 (degenerative arthritis of the spine), citing limitation of motion.  The VA also assigned a 10% rating coded 5242 (degenerative arthritis of the spine) for limitation of forward flexion of the cervical spine. The Board agreed that a 10% rating, but no higher, was justified for limitation of combined ROM (greater than 170 degrees but not greater than 335 degrees) reported on the MEB NARSUM and C&P examinations.  Although there was muscle spasm noted at the C&P examination, it was not severe enough to result in abnormal gait or spinal contour, thus the next higher 20% rating was not justified on this basis.  The Board also considered if additional disability rating was justified for peripheral nerve impairment due to radiculopathy.  The CI reported radiating pain to the shoulders, left greater than right.  However, upper extremity examination was normal at both the MEB NARSUM and C&P examinations and the EMG of the LUE did not show evidence of a radiculopathy.  Radiating pain from the neck condition is subsumed under the general spine rating criteria, which specifically states “with or without symptoms such as pain (whether or not it radiates).”  There was no evidence of a radiculopathy with functional impairment with a direct impact on fitness that was separately impaired the CI’s duty performance.  The Board therefore concluded that additional disability rating was not justified on this basis.  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 degenerative arthritis of the cervical spine condition.

BOARD FINDINGS:  In the matter of the degenerative arthritis of the cervical spine 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 20140219, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB						

MEMORANDUM FOR Commander

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXXXXX, AR20160008275 (PD201400901)

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