RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01515
BRANCH OF SERVICE:  navy 	SEPARATION DATE:  20041027

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Equipment Operator, medically separated for “cervical herniated disc” with a disability rating of 20%.  

CI CONTENTION:  “If it weren’t for the injury, I would have served and retired after 20 years.  Condition has worsened.”  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 - 20040720	VARD - 20050613	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Cervical Herniated Disc	5237-8610	20%	Cervical Strain with Herniated Nucleus Pulposus	5237	10%	20050105	
Cervical Spondylosis	Cat II					
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  30% 	

ANALYSIS SUMMARY:  

Cervical Herniated Disc.  According to the service treatment record and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s neck condition began in January 2003 after lifting plumbing pipes.  Electro diagnostic studies on 28 January 2003 showed no pathological findings in the medial nerve or in the right upper brachial plexus.  There was discrete right C5-C6 radicular compromise.  The CI was right-hand dominant.  An MRI study of the cervical spine on 7 March 2003 revealed no abnormalities in the posterior alignment, height, or signal intensity from the vertebrae.  There was a decrease of the height of the C5-C6 disc with a decrease of its signal intensity in T2 sequences of a degenerative type.  
During the 25 March 2003 visit to orthopedics, the examiner noted upper extremity radiculopathy and symptoms were not getting better.  He was diagnosed with right upper extremity C6 radiculopathy and was referred to a spinal surgeon.  At the 14 April 2003 primary care clinic follow up appointment, there was right upper extremity weakness with spasm.  There was no reported loss of bowel or bladder control, but pain reportedly now spread to the left upper extremity as well.  The final diagnosis was C5-C6 radiculopathy and disk herniation with low back pain and the CI was referred to the spine surgeon.  An MRI of the cervical spine on 7 May 2003 revealed no evidence of abnormal signal within the visualized vertebral bodies to suggest acute fracture, marrow edema, or marrow replacement.  There was minimal levo convex scoliosis of the cervical spine centered at the C5 level; and 3-4 mm central and left paracentral disc herniation at the C5-C6 level which narrowed the thecal sac to 8-9 mm with mild compression of the spinal cord.  There was also very minimal central disc bulge at the C4-C5 level without evidence of disc herniation.  A diagnosis of cervical spondylosis with disc herniation at C5-C6 causing left C6 radiculopathy was rendered.

The 28 May 2004 MEB NARSUM examination, 5 months prior to separation, noted complaints of neck pain.  Physical examination noted that the CI reported intermittent numbness in the left upper extremity.  He had intermittent cramping of his left hand.  The symptoms became worse with driving, marching, lifting, running, impact activities, and prolonged sitting.  The CI had physical therapy and epidural steroid injections without improvement.  A civilian neurosurgeon noted the CI had full strength in both upper extremities, except for 4+/5 in the left triceps.  He had full range of motion (ROM) in his neck, with sensation intact in both upper extremities.  Reflexes were normal in the biceps but 0 in the triceps.  ROM was additionally limited by pain after repetitive use and pain had the major functional impact.  An MRI study of the cervical spine showed a herniated disc at C5-C6 with spondylosis.  The CI was taking Vicodin chronically for the neck and low back pain.  

At the 5 January 2005 VA Compensation and Pension (C&P) evaluation, 3 months after separation, the CI reported neck pain.  Physical examination showed the pain reported as constant, localized and aching, sharp, sticking and cramping in nature.  Pain intensity was reported at 3/10 and was elicited by physical activity and stress.  Pain was relieved by rest, medication of Vicodin or Motrin, and hot baths.  There were no reports of incapacitation and no functional impairment noted.  Examination of the cervical spine showed the CI with normal gait and posture.  There was no evidence of radiating pain on movement with no evidence of muscle spasm or tenderness.  The cervical spine ROM measurements recorded active flexion to 40 degrees (normal 45) with combined ROM of 295 (normal 340).  ROM was additionally limited after repetitive use.  Pain had the major functional impact.  ROM was not limited by fatigue, weakness, lack of endurance, or incoordination.  There was no ankylosis of the spine noted.  Neurological examination showed normal and equal biceps and triceps reflexes.  X-rays of the cervical spine were normal.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the neck condition 20%, coded 5237-8610 (neuritis of the upper radicular group due to cervical strain).  The PEB also listed cervical spondylosis as a related Category II condition (a condition which contributed to the primary unfitting condition but was not separately ratable).  The impairment from the cervical spondylosis was properly subsumed under the overall rating for the cervical herniated disc IAW §4.14 (avoidance of pyramiding; more than one rating based on the same impairment is prohibited).  The VA rated the neck condition 10%, coded 5237 (cervical strain), citing limitation of forward flexion.  

The NARSUM examination noted the presence of left upper extremity numbness, cramping in the left hand, absence of the triceps reflex, and slight weakness of the left triceps muscle.  The General Rating Formula for Diseases and Injuries of the Spine includes symptoms such as pain, stiffness, or aching in the affected area of the spine.  The NARSUM findings suggest other neurological issues due to the cervical strain, coded 5237.  The panel agreed that a 20% rating was justified for associated unfitting radiculopathy under the 8610 code.  There was no evidence of moderate neuritis to meet criteria for a higher 30% (minor) rating.  The panel also noted the May MRI evidence of minimal cervical scoliosis, an abnormal contour, which would also meet criteria for 20% rating.  There was no evidence of intervertebral disc syndrome which resulted in incapacitating episodes requiring physician-prescribed bed rest to warrant consideration of rating under the alternate VASRD formula for that condition.  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 herniated disc condition.  

BOARD FINDINGS:  In the matter of the cervical herniated disc condition and IAW VASRD §4.71a, the panel 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 20161013, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs 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 USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN

	XXXXXXXXXXXXXXXXXX
	Acting