RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX 	CASE:  PD-2017-01094
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20061101

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a National Guard E4, Bradley Fighting Vehicle System Mechanic, medically separated for “chronic neck pain” and “chronic pain, right shoulder,” rated 10% and 0%, respectively, with a combined disability rating of 10%.  

CI CONTENTION:  In addition to his neck and right shoulder conditions, the CI also requested review of additional conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB).  

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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the 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 - 20061017	VARD - 20080130	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Neck Pain	5241	10%	Residuals of Cervical Spine Injury	5241	10%	20070914	
Chronic Pain, Right Shoulder	5099-5003	0%	Degenerative Joint Disease, Right Shoulder	5201-5010	10%	20070914	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Chronic Neck Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI was involved in an IED blast in December 2005.  An MRI of the cervical spine revealed a C6-7 disc protrusion, likely affecting the left C7 nerve root.  The CI underwent surgery with a discectomy and fusion in May 2006.  Two months after surgery, electro-diagnostic studies were reported as normal and the provider documented, “The surgery helped resolve the left upper extremity paresthesia (altered sensation).”  

The 22 August 2006 MEB NARSUM examination, 3 months prior to separation, noted complaints of constant 7/10 neck pain and also intermittent numbness and tingling in the left arm.  The physical examination (PE) revealed tenderness about the mid to lower cervical spine with adjacent left-sided muscle spasms.  The cervical spine range of motion (ROM) study measured flexion of 40 degrees (normal 45) and combined ROM of 300 degrees (normal 340), with painful motion.  A primary care encounter on 5 January 2007, 2 months after separation, revealed tenderness and spasms about the cervical spine.  An emergency room encounter on 6 April 2007, 5 months after separation, documented “painless ROM” of the cervical spine.  

At the 14 September 2007 VA Compensation and Pension (C&P) examination, 10 months after separation, the CI reported being unable to work because of his neck injury.  Under the PE section, it was documented to “refer to orthopedic consultation.”  However, after a thorough investigation of the case file, no such orthopedic consultation was found.  

The panel directed attention to its rating recommendation based on the above evidence.  Both the PEB and VA utilized the same VASRD code of 5241 (spinal fusion), and rated the neck condition at 10%.  The PEB citied ROM limited by pain, with localized tenderness, whereas the VA cited forward flexion of the cervical spine greater than 30 degrees but not greater than 40 degrees.  The panel agreed that a 10% rating, but no higher, was justified for limitation of flexion (greater than 30 degrees but not greater than 40 degrees) as reported on the NARSUM examination.  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.  After due deliberation, considering all 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 neck condition.  

Chronic Pain, Right Shoulder.  Pursuant to the IED explosion incident as previously described, the CI injured his right shoulder.  Initial X-rays revealed early hypertrophic changes about the right shoulder joint.  The MEB NARSUM examination, noted complaints of intermittent 5/10 right shoulder pain occurring with certain exercises or motions.  The PE revealed positive impingement signs in the right shoulder, thus corresponding to hypertrophic tissue within the joint as radiologically identified.  Tenderness and swelling was present in the right shoulder when compared to the left.  The ROM study of the right shoulder noted normal, but painful, flexion and decreased and painful abduction to 130 degrees (normal 180).  At the VA C&P examination, the CI reported degenerative joint disease of the right shoulder.  As reported under the neck condition, the referred to orthopedic consultation was not found in the file.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right shoulder condition 0%, analogously coded 5099-5003 (arthritis, degenerative), citing slight and intermittent pain IAW the US Army Physical Disability Agency pain policy.  The VA rated the right shoulder condition 10%, dual coded 5201-5010 (limitation of arm motion due to traumatic arthritis), based on the STR and C&P examination, citing painful or limited motion of a major joint or group of minor joints.  

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 the examinations in evidence demonstrated motion well above this level.  However, 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 and no dislocation or nonunion of the clavicle or scapula to justify a higher rating under code 5202 (humerus, other impairment of) or code 5203 (clavicle or scapula, impairment of).  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the right shoulder condition, analogously coded 5099-5003.  

BOARD FINDINGS:  In the matter of the neck condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the right shoulder condition, the panel recommends a disability rating of 10%, coded 5099-5003 IAW VASRD §4.71a.  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 Neck Pain	5241	10%	
Chronic Pain, Right Shoulder	5099-5003	10%	
COMBINED	20%	

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Dear XXXXXXXXXX:

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.