RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-01624
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20070424

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a Reserve O2, Control & Recovery Combat Rescue Officer, medically separated for “chronic neck pain” and “Left L4-5 neural foraminal stenosis with…left foot drop,” rated 10% each, with a combined disability rating of 20%.  

CI CONTENTION:  The CI contends his disability rating should be 30%.”  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 - 20070327	VARD - 20080204	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Neck Pain	5241	10%	Cervical Stenosis	5242	10%	20071219	
Left L4-5 Neuro Foraminal Stenosis 	8521	10%	L5 Radiculopathy, LLE	8720	10%		
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:  

Chronic Neck Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI underwent surgery in April 2006 with cervical decompression and fusion from C3-C7.  His left upper extremity radicular symptoms improved but did not completely resolve after surgery and his neck pain continued with limited range of motion (ROM).  The 10 August 2006 physical therapy (PT) ROM study, 8 months prior to separation, measured with an inclinometer, showed flexion of 20 degrees (normal 45) and combined ROM of 210 degrees (normal 340) with end-range pain noted.  At a PT follow-up visit on 24 August 2006, the therapist noted the CI had much better ROM after treatment, but continued to have pain with some movements.  

During the 10 January 2007 MEB NARSUM examination, 3 months prior to separation, the CI complained of daily neck pain that prevented running, bearing weight or working (including desk work).  Physical examination showed tenderness in the neck and “pronounced” decreased flexion, extension, lateral movement and rotation of the neck.  The neurologic examination was normal, with the exception of a small area of decreased light touch sensation in the lateral left thumb.  The examiner noted that since surgery, the CI had “significantly” decreased cervical ROM and pain with neck movement.   The 5 March 2007 MEB addendum, 2 months prior to separation, showed cervical ROM after three repetitions with flexion of 118 degrees and extension of 73 degrees, with painful motion and tenderness noted.  The examiner did not indicate any normal values for the measured ROMs.  There was decreased sensation in the forearm and hand.  

At the 19 December 2007 VA Compensation and Pension (C&P) examination, 8 months after separation, the CI reported daily neck pain, which prevented running, jumping, head turning or repetitive arm use (particularly overhead), sitting at a computer or driving for more than 45 minutes.  The CI denied any incapacitating episodes in the last 12 months.  Physical examination showed normal posture and spine curvature.  The neck was tender without muscle spasm.  Neck ROM was flexion of 20 degrees and combined ROM of 145 degrees, with no change after three repetitions.  Neurologic examination was normal.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the neck condition 10%, coded 5241 (spinal fusion).  The VA rated the neck condition 20%, coded 5242 (degenerative arthritis of the spine), based on the C&P examination, citing limitation of motion.  The MEB addendum with ROM in degrees indicated cervical flexion of 118 degrees and extension of 73 degrees, both much greater than VASRD normals of 45 degrees each.  The MEB NARSUM examination also simultaneously noted pronounced decreased ROM (including cervical flexion) on the physical examination and the VA ROM documented flexion of 20 degrees and extension of 15 degrees.  It appeared to the panel that the MEB examiner measured flexion and extension and failed to subtract the neutral position of the goniometer which is usually placed with the stationary arm in line with the ear and the movable arm in line with the nares.  This calculation provides flexion of approximately 30 degrees and extension of 15 degrees, which aligns these values with all other information in the record regarding cervical ROM which was moderately reduced and painful.  

The panel agreed that a 20% rating, but no higher, was justified for limitation of flexion (greater than 15 degrees but not greater than 30 degrees as reported on the C&P examination.  There was no documentation of intervertebral disc syndrome with incapacitating episodes 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 recommends a disability rating of 20% for the chronic neck pain, coded 5241.  

Left L4-5 Neural Foraminal Stenosis.  According to the STR and MEB NARSUM, the CI’s left lower extremity (LLE) weakness began as early as September 2005.  The CI presented on 30 January 2006 with complaints of dragging of his left foot with generalized weakness (magnified in cold environments).  He reported no single injury, but as above noted numerous injuries during his military career.  A lumbar spine MRI showed spinal arthritis and disc protrusion at L4-5 with severe left foraminal narrowing and lateral recess narrowing causing impingement on the L4 and L5 nerve roots.  Lumbar spine surgery with decompression was recommended, but the CI was not interested in pursuing it at that time.  

At the 29 August 2006 orthopedic appointment, 8 months prior to separation, the CI reported improved symptoms of pain, numbness and tingling in the LLE since his cervical surgery, which he attributed to resting a lot and not being involved in lifting activities.  He reported he was not having any of the pain, numbness or tingling of the LLE at all.  Physical examination showed full strength of the LLE with no weakness suggestive of foot drop.  The orthopedic surgeon indicated the CI could prudently increase his physical activity level, but without any heavy weight lifting.  

During the MEB NARSUM examination, 3 months prior to separation, the CI complained of intermittent LLE weakness with left foot drop worsened with walking and cold weather.  Physical examination showed 5/5 motor strength of the lower extremities, with normal sensation.  The MEB addendum, 2 months prior to separation, showed normal motor strength in both lower extremities with normal reflexes.  Testing was negative for nerve root impingement (negative straight leg raise).  

At the C&P examination, 8 months after separation, the CI reported intermittent weakness and paresthesia of the LLE associated with left foot drop that limited walking to less than 30 minutes.  Physical examination showed a normal posture and gait.  There was decreased strength graded 4/5 for the LLE.  Bilateral heel and right toe walking were normal, but there was mild weakness when the CI tried to rise and ambulate on the left toes.  No obvious foot drop was observed when walking across the examination room.  The left ankle reflex was diminished at 1+/2+, with all others being normal.  There was decreased sensation along the left L5 dermatome.  Straight leg raise testing was positive on the left.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the LLE condition 10%, coded 8521 (paralysis of the common peroneal nerve).  The VA also rated the LLE condition 10%, but used the 8720 code (neuralgia of the sciatic nerve), based on the C&P examination, citing mild incomplete paralysis.  

The panel agreed that a 10% rating, but no higher, was justified for mild incomplete paralysis, coded 8520 (sciatic nerve), based on intermittent LLE weakness.  There were no manifestations or symptoms in the available evidence of record severe enough to support the next higher 20% rating for moderate incomplete paralysis, such as an abnormal gait due to observed constant left foot drop or weakness.  Although the panel used a different code (8520) than the PEB (8521), there was no rating benefit to the CI and so no change to the PEB’s coding choice was recommended.  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 LLE condition.  

BOARD FINDINGS:  In the matter of the neck condition, the panel recommends a disability rating of 20%, coded 5241 IAW VASRD §4.71a.  In the matter of the LLE condition and IAW VASRD §4.124a, the panel recommends no change in the PEB adjudication.  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; and, that the discharge with severance pay be re-characterized to reflect permanent disability retirement, effective the date of medical separation:  
CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Neck Pain	5241	20%	
Left L4-5 Neural Foraminal Stenosis 	8521	10%	
COMBINED	30%	

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

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Dear XXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-01624.

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 not appropriate under the guidelines of the Veterans Affairs Schedule for Rating Disabilities.  Accordingly, the Board recommended your separation be re-characterized to reflect disability retirement, rather than separation with severance pay.

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding, accept their recommendation and determined that your records should be corrected accordingly.  The office responsible for making the correction will inform you when your records have been changed.

As a result of the aforementioned correction, you are entitled by law to elect coverage under the Survivor Benefit Plan (SBP).  Upon receipt of this letter, you must contact the Air Force Personnel Center at (210) 565-2273 to make arrangements to obtain an SBP briefing prior to rendering an election.  If a valid election is not received within 30 days from the date of this letter, you will not be enrolled in the SBP program unless at the time of your separation, you were married or had an eligible dependent child, in such a case, failure to render an election will result in automatic enrollment.