RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00983
BRANCH OF SERVICE:  Army	date of sEPARATION:  20090410 

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E7, Cannon Crewmember, medically separated for “cervical degenerative disc disease (DDD),” rated at 20%.

CI CONTENTION:  The applicant makes no specific contention in his application.  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 PEB to be unfitting for continued military service and when specifically requested by the CI, those conditions identified by the Physical Evaluation Board (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 - 20090204	VARD - 20090519 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Cervical DDD	5242	20%	DDD and Spondylitic Changes of the Cervical Spine	5243	10%	20090226	
			Radiculopathy, Right Upper Extremity	8599-8515	10%		
			Radiculopathy, Left Upper Extremity …	8599-8515	10%		
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:  

Cervical DDD.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s cervical spine condition began in July 2006 after a motor vehicle accident rollover over in a Humvee.  Radiographic studies showed multi-level (C4-C5, C5-C6, and C6-C7) cervical stenosis, degenerative disk disease, and disk herniation.  Despite physical therapy, the CI continued to report neck pain with numbness and tingling down the upper extremities.  The goniometric range-of-motion (ROM) evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.

Cervical ROM
(Degrees)	PT (for MEB) ~6 Mo. Pre-Sep
(20081023) 	VA C&P ~1 Mo. Pre-Sep
(20090226) 	
Flex (45 Normal)	30 (35 after 3 reps)	45	
Extension (45)	45 (45)	45	
R Lat Flexion (45)	45 (45)	45	
L Lat Flexion (45)	35 (33) (40 (38))	45	
R Rotation (80)	60 (70)	30	
L Rotation (80)	55 (59)	30	
Combined (340)	#	240	
Comment	AO	Spasm and abnormal spinal contour	
§4.71a Rating	10%	20%	

The NARSUM noted reports of neck pain with “shocks” from the elbows to the hands and clumsiness of the hands.  The physical examination showed no paraspinal cervical spasm, 5/5 grip strength bilaterally, and on evidence of sensory deficits.  At the VA Compensation and Pension (C&P) examination performed a month before separation, the CI reported unstable cervical pain and spasm.  The physical examination showed decreased cervical rotation ROM with pain and stiffness in all planes of motion.  There was also cervical paraspinal spasm with repetitive motion, evidence of bilateral upper extremity numbness and tingling (monofilament test), and evidence of decreased grip strength in the left hand.  Cervical spine X-rays performed 12 February 2009 demonstrated degenerative straightening indicative or muscular pain or spasm.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 20% rating under the 5242 code (degenerative arthritis of the spine), citing ROM on 1st effort not past 30 degrees forward flexion due to pain.  The VA assigned a 10% rating using the 5243 code (intervertebral disc syndrome) based on the VA C&P examination a month before separation, citing functional loss due to pain which has reduced ROM.  The Board agreed that a 20% rating, but no higher, was justified for muscle spasm or guarding severe enough to result in abnormal spinal contour, reported on the VA examination and X-ray finding.  There was no documentation of incapacitating episodes which would provide for a higher rating under that formula.  The VA assigned a 10% rating each upper extremity due to radiculopathy.  The Board also considered if additional disability rating was justified for peripheral nerve impairment due to radiculopathy.  The CI had symptoms of radiating pain documented in the treatment records; however, examinations indicated normal strength, reflexes and gait and the sensory changes did not affect his job.  The presence of functional impairment with a direct impact on fitness is the key determinant in the Board’s decision to recommend any condition for rating as additionally unfitting.  While the CI may have suffered additional pain from the nerve involvement, this is subsumed under the general spine rating criteria, which specifically states “with or without symptoms such as pain (whether or not it radiates).”  Therefore the critical decision is whether or not there was a significant motor weakness which would impact military occupation specific activities.  There is no evidence in this case that motor weakness existed to any degree that could be described as functionally impairing.  The Board therefore concluded that additional disability rating was not justified on this basis.  Considering the totality of the evidence and mindful of VASRD §4.3 (reasonable doubt), members agreed that a disability rating of 20% for the cervical degenerative disc disease condition was appropriately recommended in this case. 

BOARD FINDINGS:  In the matter of the cervical degenerative disc disease 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 20140224, 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, AR20160005808 (PD201400983)

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