RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00563
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20060715

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Network Switching System/Operator, medically separated for “chronic pain, right shoulder” and “chronic neck pain,” rated 10% and 0%, respectively, with a combined disability rating of 10%.

CI CONTENTION:  Additional unfitting conditions were not considered.  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 Medical Evaluation Board (MEB), but determined by the PEB 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.  The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence relevant to application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards for 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, which operates 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 disability at the time of separation.

RATING COMPARISON:

SERVICE PEB - 20060504	VARD - 20061026	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain, Right Shoulder	5099-5003	10%	Right Medial Upper Forearm…Radial nerve (Claimed as Right Shoulder)	8514	20%	20060502	
Chronic Neck Pain	5299-5237	0%	Cervical Intervertebral Disc Syndrome of the Radial Nerve	5243	10%	20060502	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Chronic Right Shoulder Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM),  the CI’s (right-hand dominant) right shoulder pain condition began in February 2005 when he felt his right arm pop and give way while doing pushups during physical training.  He received physical therapy, chiropractic treatments and injections without relief.  A right shoulder MRI in May 2005 was unremarkable and an X-ray study showed no fracture or other bony abnormalities.

During the 23 February 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 5 months prior to separation, the CI reported right shoulder range of motion (ROM) limited by pain.  Physical examination revealed a moderate decrease in ROM.  The 2 February 2006 MEB NARSUM examination, 5 months prior to separation, noted right arm pain which was aggravated during sleep and overhead movement.  Physical examination did not reveal right shoulder swelling, redness or warmth, or any upper extremity atrophy.  Measured ROM was flexion to 160 degrees (180) and abduction to 160 degrees (normal 180), with painful motion.  An occupational therapy examination on 27 February 2006, documented right shoulder flexion and abduction to 160 degrees; painful motion was present.

The 2 May 2006 VA Compensation and Pension (C&P) general evaluation, 2 months before separation, noted CI complaints of right shoulder, arm, and neck pain as well as right arm and hand numbness.  The pain was aggravated by physical activity and stress, but relieved with rest, and he was not receiving any treatment for his condition.  Physical examination showed no ulceration, edema or stasis dermatitis, no clubbing of the fingers or cyanosis.  The right shoulder was not examined, however, the provider wrote, “There are signs of intervertebral disc syndrome and the findings of sensory deficit of right lateral shoulder” at C5.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right shoulder condition 10%, analogously coded 5099-5003 (arthritis, degenerative), citing the US Army Physical Disability Agency pain policy.  The VA rated the condition as cervical radiculopathy causing right shoulder and right upper extremity numbness at 20%, coded 8514 (radial nerve, paralysis), based on the C&P examination, citing mild,  incomplete paralysis of hand movement.  The VASRD §4.71a threshold for rating for ROM impairment (code 5201, arm limitation of motion) is “at shoulder level” (approximately 90 degrees from the side), and members noted the examinations in evidence demonstrated motion above this level.  Although there was insufficient limitation of motion to support a rating under the 5201 code, panel members agreed that a 10% rating was justified with application of VASRD §4.59 (painful motion).  There was no malunion or recurrent dislocation of the humerus to justify a rating under the 5202 code (humerus, other impairment); and no nonunion with loose movement of the clavicle to warrant the next higher 20% rating under the 5203 code (clavicle or scapula, impairment).  The panel also determined that a nerve rating was not supported as the CI had good ROM, no motor weakness or atrophy, and right hand grip strength was within normal limits documented by orthopedic, MEB occupational therapy, and VA examinations proximate to separation.  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 right shoulder pain condition. 

Chronic Neck Pain.  According to the STR and MEB NARSUM, the CI’s neck condition began in November 2004 without noted injury or trauma.  A cervical spine MRI revealed disc desiccation (degenerative change) at C2-3, C3-4, C4-5, C5-6, and C6-7 without evidence of central canal or neural foraminal compromise.  Cervical spine X-rays in November 2005 showed no fractures or other bony abnormalities.  Electromyography studies revealed evidence of mild C6-7 cervical radiculopathy.

During the 23 February 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 5 months prior to separation, the CI reported chronic neck pain and right hand numbness, and that his hand felt cold 90% of the time.  Neck and hand physical evaluations were not documented.  The 7 February 2006 MEB NARSUM examination, 5 months prior to separation, noted complaints of neck pain accompanied by a headache triggered turning his head to the right and looking at the ceiling.  He also reported some right finger coldness and occasionally dropping things. Physical examination showed a normal gait without cervical spine tenderness or spasm.  There was no upper extremity atrophy, but the right hand was colder to touch than the left.  Cervical ROM was flexion to 45 degrees (normal) and combined ROM was 320 degrees (normal 340); painful motion was present.  An occupational therapy examination on 27 February 2006 documented flexion to 45 degrees and combined ROM of 335 degrees; painful motion was not addressed.  Right hand grip strength was within normal limits and sensory testing revealed slight diminished light touch in the right middle finger.

At the 2 May 2006 C&P general evaluation the CI reported constant neck pain, elicited by physical activity and relieved by rest and medication.  Physical examination showed a normal gait and posture with no spinal tenderness or muscle spasm.  Cervical spine flexion was 45 degrees with a combined ROM of 340; Painful motion was not elicited and there was no loss of ROM due to repetition.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the neck condition 0%, analogously coded 5299-5237 (cervical strain), citing no neurologic abnormality and combined cervical ROM of 345 degrees (the referenced physical therapy note was not in evidence).  The VA rated neck condition 10%, coded 5243 (intervertebral disc syndrome (IVDS)), citing the 10% criteria under the general spine rules.  Members agreed that a 10% rating, but no higher, was justified for combined ROM (greater than 170 degrees but not greater than 335 degrees), as recorded by the MEB NARSUM and occupational therapy examinations proximate to separation.  Although the VA examination, also proximate to separation, recorded full cervical spine ROM, the preponderance of STR evidence supports a 10% disability.  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 IVDS with incapacitating episodes which would provide for a higher rating under that formula.

The panel next considered if additional disability rating was justified for peripheral nerve impairment due to radiculopathy.  While the CI may have suffered additional pain from the nerve involvement, this is subsumed under the General Spine Rating criteria, which specifically states “with or without symptoms such as pain (whether or not it radiates).”  Therefore the critical decision is whether or not there was a significant motor weakness which would impact military occupation-specific activities.  Although the electrodiagnostic studies supported some level of radicular nerve involvement, the occupational therapy, MEB NARSUM and VA examinations, proximate to separation, did not reveal objective findings of radiculopathy or significant neurologic abnormality that would impact duty performance.  There was no motor weakness that existed to any degree that significantly interfered with satisfactory duty performance at separation.  The panel therefore concluded that an additional disability rating was not justified on this basis.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the neck condition, coded 5237.

BOARD FINDINGS:  In the matter of the right shoulder condition and IAW VASRD §4.71 the panel recommends no change in the PEB adjudication.  In the matter of the chronic neck pain, without neurologic abnormality condition, the panel recommends a disability rating of 10%, coded 5237 IAW VASRD §4.71.  There are no other conditions within the panel’s scope of review for consideration.

The panel recommends the CI’s prior determination be modified as follows, effective the date of medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Right Shoulder Pain	5099-5003	10%	
Chronic Neck Pain	5237	10%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170213, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180006523, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	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. 

	A copy of this decision has also been provided to the Department of Veterans Affairs.

Sincerely,					      
Enclosure