RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01410
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070316

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a National Guard E6, Cannon Crewmember, medically separated for “cervical neuralgia due to degenerative disc disease [DDD] of the cervical spine” with a disability rating of 20%.  

CI CONTENTION:  “Review all conditions.”  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 review of disability ratings assigned 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 or non-compensable.  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 determination 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(s) 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 - 20070202	VARD - 20070912	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Cervical Neuralgia due to DDD of the Cervical Spine	8710	20%	DJD/DDD Cervical Spine	5242	10%	20070607	
			Radiculopathy, Left Upper Extremity	8515	10%		
Diabetes Mellitus	Not Unfitting	Diabetes Mellitus	7913	20%		
Hyperlipidemia		NO VA Placement	
Hypertension		Hypertension	7107	10%	20070607	
GERD		GERD	7399-7346	0%		
Depression		PTSD	9411	30%	20070629	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Cervical Neuralgia due to DDD of the Cervical Spine.  According to the service treatment record and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the right-hand dominant CI’s left shoulder pain with radiation from his neck to his wrist began in August 2005 without any specific trauma or injury.  
An EMG on 3 November 2005 was consistent with left cervical radiculopathic process affecting the C5/6 root level.  These findings were limited however, with only the biceps and cervical paraspinals showing denervation potentials.  There was no clinical weakness noted and symptoms were noted to have improved “a great deal” since the initial onset.  A cervical MRI on 25 January 2006 showed multilevel DDD without high-grade stenosis identified.  There was no surgical indication, and conservative treatment did not result in improvement sufficient to allow unrestricted duty.  

During the 8 January 2007 MEB examination (recorded on DD Forms 2807-1 and 2808), 2 months prior to separation, the CI reported neck pain and left shoulder, arm, and hand pain.  The CI reported the left upper extremity pain included numbness and tingling in the left hand and wrist which decreased slowly, however the left thumb remained numb.  The physical examination showed left shoulder pain with specific neck motions. 

The 9 January 2007 MEB NARSUM examination, 2 months prior to separation, noted complaints of daily left (non-dominant) shoulder pain that the CI rated 2-5/10.  The physical examination showed normal strength and reflexes.  Cervical range of motion (ROM) was full with CI complaint of left shoulder pain with certain cervical ROM movements.  Shoulder ROMs were full.  

Cervical spine ROM measurements performed 12 January 2007 by physical therapy, 2 months prior to separation, were flexion 35 degrees (normal 45) and combined cervical ROM of 225 degrees (normal 340) after repetition, with pain reported.  Left shoulder ROM was full and without pain.  

At the 7 June 2007 VA Compensation and Pension (C&P) evaluation, 3 months after separation, the CI reported  neck pain radiating to his shoulder with persistent numbness of his thumb and second and third digits of his left hand.  The physical examination showed normal strength and no tenderness.  Sensation was normal to light touch in the upper extremity, but “sharp feels dull in thumb, 2nd and 3rd digits left hand.”  ROM was flexion of 45 degrees and combined cervical ROM of 290 degrees with pain at extremes.  There was no additional loss of motion with repetition.  Radiation of pain to the left arm was noted.  Shoulder examination was normal with full ROM without pain or weakness.  Reflexes were normal.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the neuralgia condition 20%, coded 8710 (neuralgia, upper radicular group [fifth and sixth cervicals]), citing “mild.”  The VA rated the left upper extremity radiculopathy 10%, coded 8515 (mild, incomplete paralysis of the median nerve).  The VA also rated the cervical degenerative joint disease 10%, coded 5242 (degenerative arthritis of the spine), based on the C&P examination 3 months after separation, citing painful motion of the cervical spine.  

The panel considered if separate peripheral nerve and cervical spine ratings, as awarded by the VA, would provide any rating higher than the 20% awarded by the PEB.  The painful (or limited) cervical ROM due to the DDD of the cervical spine would rate no higher than 10%.  The criteria for rating diseases and injuries of the spine apply with or without symptoms such as pain (whether or not it radiates), stiffness, or aching in the area of the spine affected by residuals of injury or disease.  This rating level of the peripheral nerve disability would therefore be based on only the mild sensory deficit of the left thumb and second and third digits.  This disability would be rated as mild, incomplete paralysis of the median nerve, coded 8715 (not of the upper radicular group - 8710) and would justify a 10% rating as awarded by the VA.  Separated peripheral nerve and cervical spine ratings of 10% and 10% would be a combined rating of 20%, and offer no benefit.  

After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the cervical neuralgia due to DDD of the cervical spine condition.  

Contended PEB Conditions: Diabetes Mellitus (Type II), Hyperlipidemia, Hypertension, GERD and Depression.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  Only the diabetes mellitus was profiled a P3.  The remainder of the conditions were not profiled or judged to fail retention standards.  The diabetes was reported to be stable and well controlled on oral medication with no diabetic complications.  The CI was seen by mental health in October 2006 and found fit for duty for any and all mental health conditions.  He had no limitation in regards to mental illness.  There was no performance- based evidence from the record that the contended conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for the contended conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the cervical neuralgia due to DDD of the cervical spine condition and IAW VASRD §4.124a, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the contended diabetes mellitus, hyperlipidemia hypertension, GERD and depression conditions, the panel unanimously recommends no change from the PEB determinations as not unfitting.  There are no other conditions within the panel’s scope of review for consideration.  The panel, therefore, recommends there be no modification or re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150617, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170008445, XXXXXXXXXXXXXXXXXX 

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Dear XXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction.

Sincerely,					       
						      					
Enclosure