RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2014-03317
BRANCH OF SERVICE:  MARINE CORPS 	Separation DATE:  20150108

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-3 (Mortarman) medically separated for neck pain by the Informal Physical Evaluation Board for “status post C5/6 cervical fusion” as unfitting, rated 10%.  

CI CONTENTION:  “Please consider all conditions”

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 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 Naval 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 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 - 20050617	VARD - 20051026	
Condition	Code	Rating	Condition	Code	Rating	Exam	

Status Post C5/6 Cervical Fusion

	5241	10%	Residual Scar Lateral Right Neck…	7800	10%	20050618	
			Radiculopathy…Secondary to Degenerative Disk Disease	8599-8519	10%	20050618	
			Degenerative Disc Disease with Anterior Discectomy C5-C6 Cervical Spine	5243	30%	20050618	
Right-Sided C5/6 Herniated Disk	Cat II					
Chronic Neck Pain	Cat II					
Right Shoulder AC Joint Degenerative Joint Disease	Cat III	Rotator Cuff Syndrome, and Service Evidence of Degenerative Joint Disease Acromioclavicular Joint Right Shoulder	5003-5203	10%	20050618	
Right Subscapular Bursitis	Cat III					
Right Shoulder Rotator Cuff Tendonitis	Cat III					
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 13	
COMBINED RATING:  10%	COMBINED RATING FOR ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Cervical Spine Condition.  The service treatment record (STR) indicated that the CI initially sustained a neck injury due to a motor vehicle accident (MVA) prior to service entry in 2000.  His 2001 enlistment physical noted a historical neck injury.  The CI also reported a second neck injury while in basic training (2001) which was not relieved with medications.  The first dated clinical encounter contained in the case file was in February 2004 whereby the CI reported neck pain upon movement with symptom extension into his right shoulder and arm.  A radiographic work-up revealed a cervical disc herniation at the level of C5-6 with spinal cord compression.  On 21 April 2004, he underwent an uncomplicated anterior cervical fusion with plating.  Post-operatively, the CI did well with rehabilitation with resolution of right arm symptoms.  Although follow-up radiographs revealed excellent post-operative spinal alignment, the CI persisted with neck pain and episodic right shoulder pain.  Electro-diagnostic studies performed on 24 May 2005 indicated denervation/reinnervation in the C5-6 area which appropriately correlated with the CI’s clinical history.  His LIMDU status listed ‘status post C5-6 diskectomy’ as the primary diagnosis.  The LIMDU Command endorsement stated, “[The CI] is unable to fulfill the duties of any billet within a rifle company.”             

At the MEB narrative summary (NARSUM) examination (15 April 2005; 5 months pre-separation) the CI reported the inability to do push-ups, pull-ups or perform any lifting whatsoever with the right upper extremity due to shoulder and neck pain.  His physical examination (PE) revealed decreased neck range of motion (ROM) without comment regarding painful motion.  Tenderness was present about the right shoulder while noting full ROM.  Motor strength, sensation and reflexes were normal about both upper extremities.  The NARSUM listed multiple final diagnoses to include both the neck and right shoulder as; right-sided C5-6 herniated disc status post C5-6 cervical fusion, right shoulder acromial-clavicular DJD, right shoulder rotator cuff tendonitis, and right subscapular bursitis.      

At the VA Compensation and Pension (C&P) examination (18 June 2005; 3 months post-separation), the CI reported constant neck and right arm pain described as aching, sticking, squeezing, burning, sharp, pinching, and compression which can reach a 10/10 intensity.  His painful symptoms were initiated spontaneously or by physical activity and stress.  Relief was obtained by rest.  He can function with medication.  The PE revealed tenderness and spasms about the cervical spine.  Cervical ROM was decreased and painful.  The VA’s final diagnosis was degenerative disc disease of the cervical spine status post anterior discectomy.  The goniometric 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)	MEB ~5 Mo. Pre-Sep
(20050415) 	Neuro~4 Mo. Pre-Sep
(20050603)	VA C&P ~3 Mo. Pre-Sep
(20050618)	
Flex (45 Normal)	35	50	25	
Extension (45)	45	60	10	
R Lat Flexion (45)	-	-	30	
L Lat Flexion (45)	-	-	45	
R Rotation (80)	60	75	45	
L Rotation (80)	60	75	30	
Combined (340)	-	-	185	
Comment		tenderness	tenderness; spasms; painful motion	
§4.71a Rating	10%	10%	20%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the surgical neck condition under VASRD code 5241 (spinal fusion) for a 10% rating citing 0% deduction for EPTS.  The VA coded the same condition as 5243 (intervertebral disc syndrome) at 30% citing routine VASRD criteria levels.  Board members agreed that sufficient evidence of either compensable ROM or painful motion IAW §4.59 were present throughout the entire disability evaluation process to justify the PEB’s 10% impairment rating.  Board members additionally agreed that the VA examination held a slightly greater degree of probative value given its time reference to the date of separation and therefore, both ROM parameters as well as objective physical findings support a 20% impairment rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 20% for the cervical spine condition.

The Board additionally considered if the symptomatic right upper extremity radiculopathy-like symptoms warranted additional disability rating; but, members agreed that the requisite link of any neuropathy symptoms with functional impairment was not in evidence.  Any pain component of a radiculopathy/neuropathy is subsumed under the general spine rating as specified in §4.71a.  The Board concluded therefore that any radiculopathy symptoms/condition could not be recommended for additional disability rating.

Other PEB Conditions.  The PEB additionally categorized the conditions of ‘right-sided C5-6 herniated disc’ and ‘chronic neck pain’ as contributing to the primary unfitting condition.  The Board members agreed that these conditions are related and included in the discussion above and therefore do not warrant consideration as separately unfitting conditions.  All related symptoms and functional impairments are subsumed under the rating for the surgical neck fusion as noted above.

Remaining Conditions.  The three remaining conditions of right shoulder AC joint degenerative joint disease, right subscapular bursitis, and right shoulder rotator cuff tendonitis were found by the PEB to be not separately unfitting and do not contribute to the primary unfitting condition.  Board members agreed that all three of the above conditions, although intimately related from an anatomical sense, were not a primary component of the unfitting cervical spine condition.  Additionally, members conceded that the minimal adverse objective findings with regard to the right shoulder did not significantly interfere with satisfactory performance of MOS duty requirements.  After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB’s fitness determinations for the any of the above contended conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the cervical spine condition, the Board unanimously recommends a disability rating of 20%, coded 5241 IAW VASRD §4.71a.  In the matter of the five other remaining (Category II and Category III) conditions, the Board unanimously recommends no change from the PEB determinations as not unfitting.  There were no other conditions within the Board’s scope of review for consideration.  

The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation:  

CONDITION	VASRD CODE	RATING	
Cervical Spine Condition 	5241	20%	
RATING	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140426, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW
               BOARDS 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS
 
Ref:   (a) DoDI 6040.44
       (b) CORB ltr dtd 4 Feb 16

      In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for the reasons provided in their forwarding memorandums, approve the recommendations of the PDBR that the following individual’s records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy’s Physical Evaluation Board:

- XXXXXXXXXXXXXXX, former USMC
-XXXXXXXXXXXXXXX, former USMC 
- XXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXX, former USMC   
- XXXXXXXXXXXXXXX, former USMC 
-XXXXXXXXXXXXXXX, former USMC

						 				XXXXXXXXXXXXXXX
	Assistant General Counsel
	(Manpower & Reserve Affairs)