RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00502
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20030103

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an Air National Guard E5, Traffic Management Journeyman, medically separated for “cervical degenerative disk disease” with a disability rating of 20%.  

CI CONTENTION:  “I don’t believe the DOD applied the VA regulation properly.”  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 - 20021126	VARD - 20030709	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Cervical Degenerative Disk Disease…	5290	20%	Cervical Degenerative Disk Disease…	5293-5290	30%	20030402	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Cervical Degenerative Disk Disease (DDD).  In accordance with DoDI 6040.44, the panel is required to recommend a rating IAW the VASRD in effect at the time of separation.  The panel noted that the 2002 VASRD standards for the spine, which were in effect at the time of separation, were changed to the current §4.71a rating standards in 2004.  The panel must correlate the above clinical data with the 2002 rating schedule.  Applicable diagnostic codes include: 5290 (limitation of cervical spine motion) and 5293 (intervertebral disc syndrome; based on incapacitating episodes).  

According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the right-dominant CI initially injured her right shoulder in January 2001 and reinjured it in October 2001 after heavy lifting.  An X-ray showed a possible minimal separation of the right ACJ (acromio-clavicular joint, the joint between the collar bone and shoulder blade).  She was referred to physical therapy for rehabilitation, but had persistent pain despite treatment.  An MRI in January 2001 was noted by orthopedics to be negative for a tear, but show an increased signal of the supraspinatus muscle consistent with a rotator cuff strain.  Flexion and abduction were both limited to 120 and 100 degrees, respectively (normal 180).  In orthopedics on 8 March 2002, the CI was evaluated in orthopedics and noted to have signs of impingement.  Flexion and abduction were both limited to 90 degrees.  She continued physical therapy and at a follow-up orthopedic appointment one month later, 4 April 2002, both had increased to 100 degrees.  On 22 April 2002, she had full but painful motion for flexion and abduction.  Signs of impingement were now absent.  The neck also had full but painful motion.  The neurological examination was normal.  It was noted that a shoulder X-ray was normal.  MRI from 18 December 2001 was noted as showing mild tendonitis vice a partial tear of the right rotator cuff.  Clinically she was thought to have the former.  In physical therapy on 26 April 2002 the shoulder “elevation” was normal on the left and 160 degrees on the right.  In orthopedics 2 weeks later, the motion of the cervical spine was normal but painful.  No comment on the range of motion (ROM) of the right shoulder was recorded.  Degenerative changes were seen on an X-ray of the cervical spine and a follow on MRI, accomplished on 14 May 2002, showed a moderate central disc protrusion at C5-6.  A repeat X-ray of the cervical spine on 2 May 2003 was normal.  Despite continued physical therapy, non-steroidal pain medications, trigger point injections, Botox injections, and cervical epidural steroid injections, the CI continued to have pain and duty limiting profiles.  The CI continued to be seen in physical therapy and reported improvement in the right shoulder pain.  Motion was reduced 10 degrees compared to the left (which had been recorded as normal on prior examinations).  On 13 June 2002, it was noted in physical therapy that supine elevation (flexion) was 180 degrees on the left (normal) and 165 degrees on the right.  The CI was seen in physical medicine for trigger point injections.  On 17 July 2002, she was noted was noted to “have decreased abduction above 90 degrees, but is able to do so.”  She enjoyed pain relief following the injections for one week.  On follow up on 11 September 2002, she was noted to have full ROM of the cervical spine.  The neurological examination was intact.  

The MEB NARSUM examination was dated 30 October 2002, 3 months prior to separation.  It noted that the CI had been on a profile for over a year due to cervical and right shoulder pain.  The physical examination showed minimal tenderness in the muscles between the neck and shoulder on the right.  Right shoulder abduction was decreased above 90 degrees (but not recorded as limited to 90 degrees).  The CI was thought to have cervical DDD (degenerative disc disease) with myofascial spasm of the right trapezius and levator scapulae (muscles of the neck and shoulder).  

At the VA Compensation and Pension (C&P) evaluation performed on 2 April 2003, 3 months after separation, the CI complained of constant neck pain aggravated by raising the shoulders above her head.  The physical examination showed tenderness to palpation.  C-spine ROM showed flexion at 30 degrees (normal 45) and a combined ROM of 190 degrees (normal 340).  The shoulder showed flexion of 120 degrees on the right and 180 degrees on the left (normal 180) and abduction of 90 degrees on the right and 180 degrees on the left (normal 180), external and internal rotation were 70 degrees on the right and 90 degrees on the left showing moderate to severe restriction of motion.  The neurological examination showed decreased grip strength on the right compared to the left.  X-rays of the neck were normal and of the right shoulder as well, other than a suspicion of a minimal separation of the ACJ.  Incapacitation was not recorded.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the cervical DDD condition 20%, coded 5290 (spine, limitation of motion of, cervical, at the moderate level).  The VA rated the cervical DDD condition 30%, coded 5293-5290, (intervertebral disc syndrome and spine, limitation of motion of, cervical, at the moderate level), based on the C&P examination 3 months after separation, citing a combined impairment for the neck and shoulder noting that the former warranted a 10% rating, but adding 20% for the limitation in abduction of the right shoulder.  The PEB found the CI unfit for cervical DDD associated with spasm of the right trapezius and right levator scapulae.  The MEB noted the cervical DDD and the profile noted only the neck condition.  While the clinical record showed some entries for either a rotator cuff strain or for an ACJ separation, a specific shoulder condition was not consistently diagnosed and the shoulder was not specifically addressed by either the PEB or MEB.  The panel did note for the record though that the majority of ROM measurements of the shoulders proximate to separation showed that both abduction and flexion were above the shoulder level and some were normal.  The NARSUM examiner noted that the arm motion was above the shoulder level; the C&P measurements were outliers from other measurements.  Were the shoulder in scope, a 10% rating for non-compensable limitation in motion and painful motion with X-ray findings could be supported under the code 5003 (degenerative arthritis).  However, the panel also noted that the limitation in motion of the neck only supported a 10% rating and that a combined 20% rating would be recommended providing no advantage to the CI.  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 modification or re-characterization of the CI’s disability and separation determination. 

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20120712, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD  20762

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2016-00502.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate.  The Board recommended no re-characterization or modification of your separation.

I carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  I accept their recommendation that your application be denied.

Sincerely,

Attachment:
Record of Proceedings