RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00859
BRANCH OF SERVICE:  Navy 	SEPARATION DATE:  20070801

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Gun Crew and Seamanship Specialist, medically separated for “degenerative disk disease, C5-C6” with a disability rating of 0%.

CI CONTENTION:  The CI made no specific contention 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 based upon a 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 - 20070516	No VA rating decision in evidence	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Degenerative Disk Disease, C5-C6	5243	0%		
Exercise-Induced Radiculopathy, Upper Extremities	Cat II		
Bulging Disc	Cat II		
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Degenerative Disk Disease (DDD), C5-C6.  According to service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s DDD of the neck condition began in the autumn of 2006 associated with training for a test to be a rescue swimmer.  The CI denied any specific injury or trauma.  Cervical spine X-rays 21 November 2006, 8 months prior to separation, showed normal alignment with the exception of mild straightening of the normal cervical lordosis.  Disc spaces were well maintained, and there was no significant degenerative change noted.  
Magnetic resonance imaging (MRI) performed 28 February 2007, 5 months prior to separation, showed desiccation of the C5-C6 disk with very mild posterior bulging and no evidence of impingement of the cervical spinal cord or evidence of neuroforaminal narrowing.  There was no surgical indication, and conservative treatment did not result in improvement sufficient to allow unrestricted duty. The MEB forwarded “degenerative disc disease C5-6,” “bulging disc C5-6” and “exercise induced radiculopathy, upper extremities” for PEB adjudication.  

At the time of the aviation medicine clinic appointment on 21 November 2006, the examiner recorded that the CI denied chronic neck and back pain, and he had no radicular symptoms.  The CI did report that there was a "tingling" sensation overlying his right scapula but no paresthesias of right upper extremity (RUE).  On examination the cervical spine showed no abnormal curvature.  There was no tenderness, “motion was normal” and pain was not elicited by motion.  The examiner did note weakness of the right shoulder with movements. 

The MEB NARSUM examination on 4 April 2007, 4 months prior to separation, noted complaints of numbness progressing to pain in the upper extremities when he performed strenuous physical activities.  Periods of rest provided some relief but as soon as the CI returned to strenuous activities, including the prescribed physical therapy, his symptoms increased.  Physical examination showed a normal gait and “free range of motion of the cervical spine without tenderness or guarding.”  There was no radicular symptomatology noted.  There was no tenderness noted and no muscle spasm.  

There was no limitation of cervical spine motion to support a rating under the General Rating Formula for Diseases and Injuries of the Spine and the MEB examination did not note the presence of painful motion, muscle spasm, guarding or localized tenderness.  There was no history or evidence of vertebral body fracture with loss of 50 percent or more of the height, nor was there evidence of additional functional loss that would impact functioning in the average civil occupation. 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 DDD of the neck condition.

Exercise-Induced Radiculopathy, Upper Extremities: The Board’s main charge is to assess the fairness of the PEB’s determination that the Category II condition of exercise-induced radiculopathy, upper extremities was not separately unfitting.  The flight surgeon notes in his initial and subsequent evaluations that he was recommending duty limitations based on the changes in sensation (pain and/or numbness) and strength induced by exercise.  The exercise-induced radiculopathy was not implicated in the commander’s statement, nor were the other listed conditions.  There was reported performance-based evidence from the record that exercise-induced radiculopathy significantly interfered with satisfactory duty performance at separation as evidenced by the CI’s inability to complete his PRT or prescribed physical therapy.  After due deliberation, the Board concluded that there was sufficient cause to recommend a change in the PEB fitness determination and that the exercise-induced radiculopathy be found to be separately unfitting.  

At the aviation medicine clinic appointment on 18 January 2007, 6 months prior to separation, the CI reported he was able to do 30 push-ups in 1 minute.  However, by continuing to 35 push-ups, his right arm began to feel week and “tingly.”  At 37 push-ups, he was unable to lift himself up from the right side.  He also reported a global, circumferential numbness of the entire RUE from the shoulder to the fingers.  He had a global weakness of his RUE and was unable to lift his arm and could barely move his fingers.  The symptoms resolved over a period of hours.  Physical examination showed a normal neck evaluation.  The neurological examination was significant for decreased sensation to fine touch in the RUE.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the neck condition 0%, coded 5243 (intervertebral disc syndrome).  The PEB also listed “exercise-induced radiculopathy, upper extremities” and “bulging disc” as related Category II conditions (conditions that contributed to the primary unfitting condition but were not separately ratable).  The Board concluded the impairment from the bulging disc was properly subsumed under the overall rating for the degenerative disk disease, C5-C6 IAW §4.14 (avoidance of pyramiding; more than one rating based on the same impairment is prohibited).  

There was no limitation of cervical spine motion to support a rating under the General Rating Formula for Diseases and Injuries of the Spine and the Branch Clinic and MEB NARSUM examinations did not note the presence of painful motion, muscle spasm, guarding or localized tenderness.  There was no history or evidence of vertebral body fracture with loss of 50% or more of the height, nor was there evidence of additional functional loss that would impact functioning in the average civil occupation.  

The impairment from the exercise-induced radiculopathy was improperly subsumed under the overall rating for the degenerative disc disease for the reasons stated above.  There was a significant change in sensation of the entire RUE as well as weakness of the RUE after exercise beginning with the CI training to become a rescue swimmer.  Although all of these symptoms were not present all of the time, after upper extremity exercises such as push-ups or the physical therapy exercises the CI experienced an increase in pain and numbness (sensation) as well as weakness (motor) in the RUE that resolved over the next several hours.  The Board noted that these symptoms were present in the CI’s dominant upper extremity.  The VASRD gives guidance for rating diseases of the peripheral nerves stating that “the term incomplete paralysis with this and other peripheral nerve injuries indicates a degree of lost or impaired function substantially less than that the type pictured for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration.  When the involvement is wholly sensory, the rating should be mild, or at most, the moderate degree.”  The Board took note that although the symptoms included motor and sensory components, they were transient and only occurred after exercise justifying a 20% rating coded 8513 (paralysis of peripheral nerve, all radicular groups, mild).  The evidence did not support a higher 40% rating for moderate paralysis of a peripheral nerve due to symptoms being transient and only present after exercise.  

After due deliberation, the Board agreed that the preponderance of the evidence with regard to the functional impairment of the exercise-induced radiculopathy, upper extremities favors its recommendation as an additionally unfitting condition for disability rating.  It is appropriately coded 8513 and meets the VASRD §4.124a criteria for a 20% rating.  

BOARD FINDINGS:  In the matter of the DDD 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 Category II bulging disc condition, the Board unanimously agrees that it cannot recommend it for additional disability rating.  In the matter of the contended exercise-induced radiculopathy, upper extremities condition, the Board unanimously agrees that it was unfitting and the Board majority recommends a disability rating of 20%, coded 8513 IAW VASRD §4.124a.  The single voter for dissent recommended a rating of 40% and did not elect to submit a minority opinion.  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	
Exercise-Induced Radiculopathy, Upper Extremities	8513	20%	
Degenerative Disc Disease, C5-6	5243	0%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150607, with attachments
Exhibit B.  Service Treatment Record

MEMORANDUM FOR COMMANDER, NAVY PERSONNEL COMMAND	
	                          
Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS          

Ref:  (a) DoDI 6040.44
	(b) PDBR ltr dtd 25 Nov 16 ICO XXXXXXXXXXXXXXXXXX    
	(c) PDBR ltr dtd 19 Nov 16 ICO XXXXXXXXXXXXXXXXXX
	(d) PDBR ltr dtd 19 Nov 16 ICO XXXXXXXXXXXXXXXXXX
	(e) PDBR ltr dtd 17 Nov 16 ICO XXXXXXXXXXXXXXXXXX
	(f) PDBR ltr dtd 25 Nov 16 ICO XXXXXXXXXXXXXXXXXX
	(g) PDBR ltr dtd 19 Nov 16 ICO XXXXXXXXXXXXXXXXXX
	(h) PDBR ltr dtd 19 Nov 16 ICO XXXXXXXXXXXXXXXXXX
	(i) PDBR ltr dtd 17 Nov 16 ICO XXXXXXXXXXXXXXXXXX

1.  Pursuant to reference (a), the recommendations of the Physical Disability Board of Review set forth in references (b) through (i) are approved.

2.  The official records of the following individuals are to be corrected to reflect the stated disposition:
     
     a. XXXXXXXXXXXXXXXXXX, former USN: Effective date of discharge, retroactive placement on the Temporary Disability Retired List with a 50 percent disability rating for six months, followed by a final disability rating of 10 percent. 

     b. XXXXXXXXXXXXXXXXXX, former USN: Retroactive placement on the Permanent Disability Retired List with a 40 percent disability rating (increased from 20 percent) effective date of discharge.  

     c. XXXXXXXXXXXXXXXXXX, former USN: Retroactive placement on the Permanent Disability Retired List with a 60 percent disability rating (increased from 10 percent) effective date of discharge.  

     d. XXXXXXXXXXXXXXXXXX, former USN: Retroactive placement on the Permanent Disability Retired List with a 30 percent disability rating (increased from 10 percent) effective date of discharge.  

     e. XXXXXXXXXXXXXXXXXX, former USN: Effective date of discharge, entitlement to disability severance pay with a 20 percent disability rating (increased from 10 percent).   

     f. XXXXXXXXXXXXXXXXXX, former USN: Effective date of discharge, entitlement to disability severance pay with a 20 percent disability rating (increased from 10 percent).  

     g. XXXXXXXXXXXXXXXXXX, former USN: Effective date of discharge, entitlement to disability severance pay with a 20 percent disability rating (increased from 0 percent).

     h. XXXXXXXXXXXXXXXXXX, former USN: Retroactive placement on the Permanent Disability Retired List with a 30 percent disability rating (increased from 10 percent) effective date of discharge.     

3.  Please ensure all necessary actions are taken to implement these decisions, including the recoupment of disability severance pay, if warranted, and notification to the subject members once those actions are complete.

	XXXXXXXXXXXXXXXXXX
	Assistant General Counsel
	(Manpower & Reserve Affairs)