RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00607
BRANCH OF SERVICE:  marine corps	SEPARATION DATE:  20041215

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Rifleman, medically separated for “cervical spondylosis, L4-5 herniated nucleus pulposus” with a disability rating of 10%.  

CI CONTENTION:  “I was paralyzed from the neck down for 8 hours and rehabbed to get back on my feet.  Even though I didn’t have surgery then, I will need it.  This had led to chronic disc degeneration.”  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 - 20041026	VARD - 20050708	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Cervical Spondylosis, L4-5 Herniated Nucleus Pulposus	5237	10%	Cervical Spondylosis and Nerve Root Irritation of C6	5237	10%	20050215	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Cervical Spondylosis, with C4-5 HNP.  It is first clarified that there was no lumbar spine condition in scope.  The MEB and PEB diagnoses including “L4-5 herniated nucleus pulposus [HNP]” were almost certainly typographical errors for C4-5 as confirmed by MRI and other treatment entries. According to the service treatment record and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s neck condition began in May 2004 after strenuous overhead exertion.  During a 28 June 2004 primary care visit, the CI complained of continued neck and associated shoulder pain and numbness radiating into the right hand.  Examination showed full neck range of motion (ROM) and hand numbness with neck extension.  The examiner assessed the condition as cervical spondylosis most prevalent at C4/5.  
At a neurosurgery clinic follow-up appointment for neck pain, the CI reported less right arm pain but continued neck pain.  Cervical spine ROM in degrees was: active flexion to 60 (normal 45), extension to 45 (normal), and right and left rotation to 60 (normal 80) with no muscle spasm. Combined ROM was greater than 205 and less than 305 degrees (normal 340).  

The 23 September 2004 MEB NARSUM examination, 3 months prior to separation, noted complaints of neck pain.  Physical examination showed normal muscle strength and no joint pain or sensory deficits.  X-ray studies showed a normal cervical spine, and MRI results from 20 June 2004 showed subtle cervical spondylosis at C3/4, C6/7 and perhaps C5/6, with more prominent spondylosis at C4/5 with central and left posterolateral disk herniation.  The examiner concurred with the previous diagnoses as cervical spondylosis and C4/5 HNP.  

At the 15 February 2005 VA Compensation and Pension (C&P) evaluation, 2 months after separation, the CI reported continued neck pain with a brief period of neck spasms which lasted up to 6 hours and prevented him from turning his neck.  Physical examination revealed a normal posture and gait.  ROM measurements showed active flexion over 45 degrees and combined ROM of 290 degrees (normal 340).  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the neck condition 10%, coded 5237 (cervical strain).  The VA also rated the neck condition 10%, coded 5237, based on the C&P examination 2 months after separation. The panel agreed that a 10% rating, but no higher, was justified for combined ROM (greater than 170 degrees but not greater than 335 degrees), as reported on the neurosurgery and VA examinations.  There was no muscle spasm or guarding severe enough to result in an abnormal gait or spinal contour, thus the next higher 20% rating was not justified on this basis.  There was no documentation of intervertebral disc syndrome which resulted in incapacitating episodes requiring physician-prescribed bed rest which would provide for a higher rating under that formula.  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 cervical spine condition.  

BOARD FINDINGS:  In the matter of the cervical spine 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.  Therefore, the panel recommends 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 20160916, w/atchs
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 USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- 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 USN

		
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	     				                                      Acting