RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03341
BRANCH OF SERVICE:  Air Force                                                          SEPARATION DATE:  20060325	

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E4, Aerospace Maintenance Journeyman, medically separated for “radicular neck pain associated with degenerative disc disease,” with a disability rating of 10%.  

CI CONTENTION: The CI contends for his unfitting neck condition.  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 - 20060310	VARD - 20070921	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Radicular Neck Pain Associated with DDD	5243	10%	Residuals, Injury Cervical Spine with Disc Disease	5243	10%	20060622	
			Cervical Radiculopathy	8515	20%	20060622	
Tobacco Habituation	Category III	No VA Placement 	
History of Narcotic Addiction	Category III	No VA Placement	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Radicular Neck Pain Associated with Degenerative Disc Disease.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s neck condition began in November 2004 while working on an aircraft.  Radiographic Magnetic resonance imaging studies in February 2005 showed multilevel degenerative disc disease (DDD), degenerative joint disease (DJD), and the appearance of spinal stenosis at C4-5 and C5-6.  There was no surgical indication.  Despite treatment, the cervical spine condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for an MEB.  The MEB forwarded “radicular neck pain” for PEB adjudication.  The narrative summary (NARSUM), dated July 2005, 8 months prior to separation, indicated that the CI complained of left arm pain which radiates down into his left arm.  The physical examination recorded full range of motion (ROM) in the left upper extremity strength decreased to 4/5 compared to the normal right side (5/5).  A pain management note dated 11 November 2005 documented tenderness to palpation over the cervical muscles.  The ROM was full, but painful.  Motor function was 5-/5 on the left and normal on the right for the upper extremities with a decreased left grip.  The CI also had a “snapping scapula” on the left which could account for the mild impairment on that side.  An addendum to the NARSUM dated 21 February 2006 noted that the CI had not been seen (in that clinic) since the NARSUM was written, but that there was no interval change in his condition.  

At the VA Compensation and Pension (C&P) examination performed on 22 June 2006, 3 months after separation, the CI reported constant neck pain.  The history noted that the CI could function at the time of pain with medication and that he was having a good response to the epidurals.  He was working as a plumber.  The CI reported 93 days of incapacitation, but this is not supported by the record.  The medical officer opined that the CI might be including his convalescent leave and duty limitations in this number, but this is speculative.  Regardless, there was no evidence of physician prescribed bedrest in the record.  On examination, there was no evidence of radiating pain on movement, muscle spasm, tenderness, or ankylosis.  The posture and curvature were normal.  The ROM measurements showed flexion limited to 42 degrees (rounds to 40; VA normal is 45) and a rounded combined ROM of 305 (VA normal is 340).  Function was additionally limited following repetitive use by pain.  There were no signs of intervertebral syndrome with chronic and permanent nerve root involvement.  The neurological examination was intact including motor function.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB and VA assigned a 10% rating under code 5243 (intervertebral disc syndrome).  The VA also assigned a 20% rating for a radiculopathy, coded 8515, based on post-separation treatment records documenting treatment beginning on 23 November 2007, 14 months after separation.  The Board agreed a 10% rating was justified for the by limitation in motion, painful motion, and tenderness.  No route to a higher rating was found.  The Board then considered if additional disability rating was justified for peripheral nerve impairment due to radiculopathy.  The CI had weakness of the left upper extremity, but also a separate left shoulder condition.  The record shows improvement with treatment and the motor function was normal on the VA examination.  While the CI may have experienced radiating pain from the neck condition, this 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 objective evidence of a radiculopathy with functional impairments that were separately unfitting for duty at separation.  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 neck condition.  

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that tobacco habituation and history of narcotic addiction were not unfitting.  The Board’s threshold for countering fitness determinations requires a preponderance of evidence, but remains adherent to the DoDI 6040.44 “fair and equitable” standard.  Neither condition was profiled or implicated in the commander’s statement neither was judged to fail retention standards.  Further, uncomplicated substance use disorders do not constitute a physical disability (that is, they are not ratable) IAW DoDI 1332.38, E5.1.3.9.1.  Both were reviewed and considered by the Board.   There was no performance based evidence from the record that either condition significantly interfered with satisfactory duty performance at separation.  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 fitness determination for the either contended condition and so no additional disability ratings are recommended.

BOARD FINDINGS:  In the matter of the neck condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended tobacco habituation and history of narcotic addiction conditions, the Board unanimously recommends no change from the PEB determinations as Category III (not unfitting).  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 20140716, 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-2014-03341.

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