RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-04205
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080713

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an E5, Human Resources Specialist, medically separated for “spinal fusion C5-C6,” with a disability rating of 10%.  

CI CONTENTION:  The CI requests consideration of all conditions in the application.  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 - 20080312	VARD - 20080910	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Spinal Fusion C5-C6…	5241	10%	Intervertebral Disc Syndrome with Degenerative Arthritic Changes	5243	20%	20080523	
Bilateral Anterior Knee Pain	Not Unfitting 	Degenerative Arthritis of Right Knee Joint	5260-5010	10%		
		Degenerative Joint Disease of Left Knee	5260-5010	10%		
Hypothyroidism	Not Unfitting 	Status Post Thyroid Surgery with Residual of Scar and
Hypothyroidism	7901	0%		
Left Vocal Cord Paralysis	Not Unfitting 	Midline Paralysis Left Vocal Cord Secondary To Thyroid Surgery	6599-6516	NSC		
Right Shoulder Strain	Not Unfitting 	Bilateral Shoulder Strain	5201-5203	10%		
Pelvic Pain	Not Unfitting 	Status Post Hysterectomy with Right Ovary Removal With Residual of Scar	7618	30%		
		Left Ovary Torsion	7615	NSC		
Mild to Moderate Right Ulnar Neuropathy	Not Unfitting 	Carpal Tunnel, Tendonitis, Right Wrist…and Right Ulnar Neuropathy	5099-5024	10%		
Migraines	Not Unfitting 	Migraine Headache	8100	10%		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  90%	

ANALYSIS SUMMARY:  

Chronic Neck Pain Status Post C5-6 Cervical Fusion.  According to service treatment records and the medical evaluation board (MEB) narrative summary (NARSUM), the CI underwent cervical spine surgery with C5-6 fusion in May 2004 for a herniated disc.  Following surgery, further treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “chronic neck pain status post C5-6 cervical fusion” for PEB adjudication.  At the time of the spine clinic appointment on 1 November 2007, 8 months prior to separation, the CI reported that her neck pain had worsened over the past several years and that she had “some residual paresthesias associated with bilateral carpal tunnel syndrome despite having bilateral carpal tunnel releases.  On examination she had a normal gait, strength, sensation, and reflexes.  However, she did have “paresthesias involving bilateral upper extremities in all digits.”   Her range of motion (ROM) demonstrated forward flexion to 40 degrees (normal 45) and extension to 20 degrees (normal 45).  She had pain with ROM testing.  Radiographic studies showed spondylotic (stiffening of the vertebrae) changes above and below the fusion.  Electrodiagnostic studies on 4 December 2007, were negative for radiculopathy.  

At the MEB examination (recorded on DD Forms 2807 and 2808) dated 15 November 2007, 8 months prior to separation, the CI reported that she had tingling in her hands and feet.  Physical examination showed decreased active ROM with slight tenderness to palpation, but no spasm.  Her motor strength and reflexes were normal.  At the time of the physical therapy MEB ROM studies on 11 December 2007, 7 months before separation, the examiner recorded flexion of 25 and extension of 40, with painful motion noted in several planes.  There was no localized tenderness, muscle spasm, abnormal spinal contour, or guarding noted during the examination.  The MEB NARSUM examination on 15 January 2008, 6 months prior to separation, noted complaints of tingling in the left digits secondary to carpal tunnel syndrome.  Physical examination showed decreased ROM with tenderness to palpation over the right paraspinal muscles.  There was no muscle spasm, guarding, or abnormal spinal contour and the CI’s gait was normal.  She also had normal upper extremity strength, sensation, and reflexes.  The examiner referenced the ROM recorded at the December 2007 physical therapy visit.  

At the VA Compensation and Pension (C&P) examination on 23 May 2008, performed 2 months before separation, the CI reported “stiffness, weakness, numbness, bladder complaints and bowel complaints.”  She also reported that when she had neck pain, she could function with medication and that her condition had not resulted in any incapacitation.  Physical examination showed painful limitation of motion and tenderness, with forward flexion and extension to 20 degrees each; there was no evidence of radiating pain on movement or ankylosis.  The CI had normal posture and reflexes.  Although there were signs of intervertebral disc syndrome, there was no motor weakness.  However, the examiner noted sensory deficits of the bilateral forearms, thumbs, index fingers and long fingers and the neurological examination revealed “motor dysfunction demonstrated by decreased sensation 4.5/5 in bilateral hands, motor power is 4.5/5.”  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the neck condition 10% under the 5241 code (spinal fusion), citing tenderness and limitation of combined motion.  The VA assigned a 20% rating using the 5243 code (intervertebral disc syndrome) based on the VA C&P examination 2 months before separation, citing forward flexion of greater than 15 degrees but not greater than 30 degrees.  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 on the physical therapy and VA examinations.  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.  Although the CI had intervertebral disc disease there were no incapacitating episodes requiring bed rest prescribed by a physician to warrant consideration of rating under the alternate VASRD formula based on incapacitating episodes due to intervertebral disc syndrome.  The Board also considered if additional disability rating was justified for peripheral nerve impairment due to radiculopathy.  There was no evidence of cervical spine nerve root involvement by electrodiagnostic studies or neurologic examination.  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 recommends a disability rating of 20% for the neck condition, coded 5241.  

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that bilateral anterior knee pain, hypothyroidism, left vocal cord paralysis, right shoulder strain, pelvic pain, and mild to moderate right ulnar neuropathy 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.  None of these conditions were implicated in the commander’s statement and none of them were judged to fail retention standards.  Only the bilateral anterior knee condition was profiled (L2).  All were reviewed and considered by the Board.  There was no performance-based evidence from the record that any of these conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, and 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 any of the contended conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the neck condition, the Board unanimously recommends a disability rating of 20%, coded 5241 IAW VASRD §4.71a.  In the matter of the contended bilateral anterior knee pain, hypothyroidism, left vocal cord paralysis, right shoulder strain, pelvic pain, mild to moderate right ulnar neuropathy 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 the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Spinal Fusion C5-C6	5241	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140829, 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 XXXXXXXXXX, AR20160011611 (PD201404205)

1.  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, accept the Board’s recommendation to modify the individual’s disability rating to 20% without re-characterization of the individual’s separation.  This decision is final.  

2.  I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum.   

3.  I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

 BY ORDER OF THE SECRETARY OF THE ARMY:

CF: 
(  ) DoD PDBR
(  ) DVA