RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00217
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20030205

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Voice Interceptor, medically separated for “right C7-8 radiculopathy with cervical herniated nucleus pulposus with chronic neck pain and right upper extremity pain” with a disability rating of 20%.  

CI CONTENTION:  The CI contends for his neck conditions and conditions not identified by either the Medical Evaluation Board (MEB) or Physical Evaluation Board (PEB). He also noted that the condition(s) continue to worsen and negatively impact his quality of life.  The complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The panel’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 panel’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 panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The panel’s assessment of the PEB rating determinations is based on 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 panel 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 panel 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 – 20021125	VARD – 20030723	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right C7-8 Radiculopathy with Cervical Herniated Nucleus Pulposus with
Chronic Neck Pain and Right Upper Extremity Pain	5293

8799-8711 	20%	Degenerative Disc Disease, Cervical Spine, with Painful Motion	5293-5290	10%	20030408	
			Cervical Radiculopathy, Right Upper Extremity	5293-8515	10%		
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Right C7-8 Radiculopathy with Cervical Herniated Nucleus Pulposus with Chronic Neck Pain and Right Upper Extremity Pain.  According to the service treatment record (STR) and the MEB narrative summary (NARSUM), the right-hand dominant CI’s neck condition began in the fall of 1999 without any precipitating injury.  

The 1 November 2002 MEB NARSUM examination, 3 months prior to separation, noted complaints of chronic neck pain and right-sided radicular symptoms.  Physical examination revealed range of motion (ROM) in degrees as neck extension limited to 20, neck flexion limited to 35, left- and right-sided rotation to 30, and lateral bending to 20 bilaterally.  The physical examination of his upper extremity motor function revealed 5/5 deltoid, triceps, biceps, wrist extensors, wrist flexors, and interossea.  His reflexes were 2+ and equal to biceps, brachioradialis and triceps.  His sensation was grossly intact.  He had no long tract signs.  MRI obtained on 14 June 2002 revealed evidence of right paracentral disk bulges with narrowing of the neural foramina at the C3-C4 level, moderate disk osteophyte complex associated spurring at the C4-C5 level and also a right-sided paracentral disk herniation at C5-C6 which displaced the cord, as well as results in mild canal diameter narrowing consistent with early stenosis.  

At the 8 April 2003 VA Compensation and Pension (C&P) evaluation, 2 months after separation, the CI reported difficulty turning his head particularly when driving as well as ongoing right arm pain and numbness with repetitive work.  The physical examination showed the CI’s cervical spine had tenderness on the right side of the neck.  Signs of radiculopathy were subjective.  There was some muscle spasm.  ROM in degrees was flexion 60 with pain at the end, extension 45, right lateral flexion 35 with pain at the end, left lateral flexion 35, right rotation 35, and left rotation 35.  There was no ankylosis, fatigue, weakness, lack of endurance, and incoordination.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the neck condition 20%, by using two codes for one unfitting condition: 5293 (limitation of motion of cervical spine) and 8799-8711 (intervertebral disc syndrome and neuralgia middle radicular group).  The VA rated the neck condition 10%, combining codes 5293-5290 (limitation of motion of cervical spine and intervertebral disc syndrome), based on the VA C&P examination 2 months after separation, citing degenerative disc disease of the cervical spine, with painful and slightly limited motion.  The VA also rated the related radiculopathy condition 10%, combining codes 5293-8515 (limitation of motion of cervical spine and paralysis of the median nerve), based on the C&P examination 2 months after separation, citing mild incomplete paralysis of right hand movements.  

The panel agreed that a 10% rating, but no higher, was justified for cervical spine limitation of motion reported on both the NARSUM and C&P examinations proximate to separation.  The panel also considered if additional disability rating was justified for peripheral nerve impairment due to radiculopathy.  The CI reported left-hand numbness but MRI and EMG studies did not support other than C 5-6 neural foraminal narrowing that could result in some level of radicular nerve irritation or involvement. Physical examinations (MEB NARSUM, and VA C&P) proximate to separation revealed no objective findings of radiculopathy that would impact duty performance.  The presence of functional impairment with a direct impact on fitness is the key determinant in the panel’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 neurologic impairment which would impact military occupation-specific activities.  There was no evidence in this case that a neurologic abnormality existed to any degree that could be described as functionally impairing.  The panel 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 panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the neck condition.  

BOARD FINDINGS:  In the matter of the neck condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  There are no other conditions within the panel’s scope of review for consideration.  The panel, 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 20150316, 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

17 Apr 2017

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20170005964 (PD-2015-00217)

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