RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  pd-2016-00123
BRANCH OF SERVICE:  MARINE CORPS 	SEPARATION DATE:  20030315

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Warehouse Clerk, medically separated for “cervical herniated nucleus pulposus at C6/C7 and bulges at C4/C5 and C5/C6” and “neck pain and radiculitis,” with a combined disability rating of 20%.  

CI CONTENTION:  The CI contends the neck and radicular shoulder conditions continue to worsen.  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 - 20030124	VARD - 20030319	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Cervical Herniated Nucleus Pulposus at C6/C7 and Bulges at C4/C5 and C5/C6	5290-5293	20%	Residuals, Cervical Disc Disease	5293-5290	10%	20030219	
Neck Pain and Radiculitis	Cat II					
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

Cervical Herniated Nucleus Pulposus at C6/C7 and Bulges at C4/C5 and C5/C6.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s neck condition began in May 2000 after a motor vehicle accident that occurred 4 months earlier.  Radiographic studies at the time were normal, but an MRI in July 2002 showed “mild to moderate central canal stenosis involving the cervical levels extending from the C3-4 through C6-7 due to central disc bulge/annular tear.”  There was “no neural foraminal involvement.”  Electro diagnostic studies done in September 2002 showed evidence of mild bilateral C5 radiculopathy.  The evaluating neurosurgeon did not recommend surgical intervention.

During the November 2002 MEB examination (recorded on DD Forms 2807 and 2808) 4 months prior to separation, the CI reported “numbness and tingling in upper extremities.”  Physical examination showed tenderness to palpation.  There were no other pertinent findings in this examination.  The 6 December 2002 MEB NARSUM examination, 3 months prior to separation, noted complaints of pain and decreased neck range of motion (ROM) with numbness in his left greater than right arm.  “His pain increased with cold weather, prolonged standing, immobility and lifting.”  Physical examination showed flexion and extension of 45 degrees (normal 65 and 50 respectively) and bilateral rotation of 50 degrees (normal 80).  He had mild muscle spasm and moderate tenderness, but there was no report of abnormal spinal contour or guarding.  His motor strength and reflexes were normal, but he had subjective decreased pinprick sensation in his left hand.  

At the 19 February 2003 VA Compensation and Pension (C&P) evaluation, 1 month before separation, the CI reported neck “stiffness, numbness, tingling, and pain.”  His pain radiated to his shoulders, but did not radiate down his arms.  However, he reported intermittent parasthesias in his hands.  The CI also reported having 20 incapacitating episodes within the previous 12 months causing him to miss 6-7 days of work.  Physical examination showed normal posture and gait without radiation of pain on movement.  Muscle spasm and tenderness were present, but there was no report of guarding.  His cervical ROM was painful and limited in all planes of motion.  Flexion was 30 degrees, extension was 30 degrees, lateral flexion was 25 degrees bilaterally (normal 40); and rotation was 45 degrees bilaterally.  He had normal motor strength, reflexes, and sensation in his upper extremities.  

The panel directed attention to its rating recommendation based on the above evidence.   The PEB rated the neck condition 20%, coded 5290-5293 (moderate cervical limitation of motion due to intervertebral disc syndrome).  The Navy PEB’s Category II diagnosis of neck pain and radiculitis is intrinsic to the rated condition and a separate rating cannot be supported without pyramiding (VASRD §4.14); thus, it is appropriately subsumed in the same rating.  

The VA rated the neck condition 10%, coded 5293-5290 (intervertebral disc syndrome causing cervical limitation of motion, based on the C&P examination 1 month before separation, citing muscle spasms, tenderness to palpation, and decreased and painful limitation of motion.  The panel agreed there was no evidence of severe cervical limitation of motion to achieve a higher 30% rating.  Although he could no longer participate in past activities as a volunteer fireman and paramedic, he was able to drive the vehicles.  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.  In the matter of the neck pain conditions and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  There were no other conditions within the panel’s scope of review for consideration.  The panel, therefore, recommends that 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 20160315, with attachments.
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW
               BOARDS 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS
 
Ref:   (a) DoDI 6040.44

      In accordance with reference (a), I have reviewed the cases listed below and approve the recommendations of the PDBR that the following individual’s records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy’s Physical Evaluation Board:

		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN

		
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