RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01571
BRANCH OF SERVICE:  AIR FORCE	SEPARATION DATE:  20090531

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated Reserve E6, Operations Intelligence Craftsman, medically separated for “cervical degenerative disc disease,” with a disability rating of 20%.  

CI CONTENTION:  The conditions continue to worsen and negatively impact her daily activities.   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 - 20090417	VARD - 20090725	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Cervical Degenerative Disc Disease	5243	20%	Cervical Myofascial Syndrome 	5238	10%	20090424	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:

Cervical Degenerative Disc Disease (DDD).  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s cervical DDD condition began in 2006 after lifting computers.  Neck pain was variably accompanied by radiating pain to either upper extremity, as well as numbness and tingling.  Magnetic resonance imaging (MRI) studies in September 2008 showed degenerative arthritis and multilevel disc protrusions with severe right-sided neuroforaminal narrowing at C5-C6.  The CI reasonably declined a surgical option, but conservative treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “cervical radiculopathy C-5” for PEB adjudication.
 
The MEB NARSUM examination, on 29 May 2008 (12 months prior to separation), noted complaints of neck pain, and pain and numbness in her right arm.  Pain was exacerbated by lifting or sitting longer than 1 hour.  A physical therapy (PT) evaluation, on 24 July 2008 (10 months prior to separation), recorded complaints of neck pain radiating to the right side of neck and upper back.  Range of motion (ROM) measurements recorded flexion of 45 degrees (45 normal) and combined ROM of 240 degrees (340 normal).  Repeat ROM measurements, on 16 September 2008, showed flexion of 30 degrees and combined ROM of 230 degrees.

Follow-up PT ROM testing on 15 December 2008 (6 months prior to separation) found cervical flexion of 20 degrees and combined ROM of 110 degrees.  Muscle strength testing of the upper extremities was normal except for mild weakness (4/5) of both shoulders.

Neurologic testing was performed, on 25 February 2009 (3 months prior to separation), to evaluate complaints of left forearm and hand numbness and tingling.  Physical examination by the neurologist found normal muscle strength of both upper extremities.  The electrodiagnostic studies showed no evidence of left upper extremity radiculopathy, or of any peripheral neuropathy.

At the VA Compensation and Pension (C&P) examination on 24 April 2009, performed 1 week before separation, the CI reported neck and bilateral upper extremity pain associated with numbness and tingling.  She denied incapacitating episodes during the previous 12 months.  Physical examination showed a normal gait, no paraspinal muscle spasm, and normal upper extremity reflexes and muscle strength.  Painful motion and cervical muscle tenderness were present.  Cervical flexion was 30 degrees and combined ROM was 285 degrees.  There was no loss of motion after repetition. 
  
The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 20% rating under the analogous 5243 code (intervertebral disc syndrome).  The VA initially assigned a 10% rating using the analogous 5238 code (spinal stenosis) for limitation of forward flexion, but later corrected the rating to 20% effective the day after separation.  The Board agreed that a 20% rating, but no higher, was justified for limitation of flexion (greater than 15 degrees but not greater than 30 degrees) reported by the exams most proximal to separation.  The Board considered whether a higher rating (§4.7) was achieved by using the alternate rating formula based on incapacitating episodes due to intervertebral disc syndrome (IVDS).  Although the CI had intervertebral disc disease (disc disease causing neck and radiating pain), there were no incapacitating episodes requiring physician-prescribed bed rest to warrant consideration of rating under the alternate VASRD formula (for IVDS).  The Board finally considered if additional disability rating was justified for peripheral nerve impairment due to radiculopathy.  The CI had radiating pain and numbness variably reported in either upper extremity, and the MEB forwarded radiculopathy for PEB adjudication.  Although an MRI showed right-sided neuroforaminal narrowing at C5-6, physical examinations proximal to the time of separation showed completely normal neurologic findings, including muscle strength.  Furthermore, electrodiagnostic studies of the left upper extremity (performed at a time when left upper extremity complaints were present) were entirely normal.  

While the CI may have suffered additional radiating pain from 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 was 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.  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 cervical DDD condition.
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 20140218, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAF/MR
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD  20762

Dear XXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2014-01571.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate.  Accordingly, the Board recommended no re-characterization or modification of your separation.

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  Accordingly, I accept their recommendation that your application be denied.

Sincerely,

Attachment:
Record of Proceedings