RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01880
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060917

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a National Guard E4, Heavy Construction Equipment Operator, medically separated for “cervical fusion” with a disability rating of 10%.  

CI CONTENTION:  “My neck is fused from C4-C7 and I lost most mobility in my neck.  Also have extensive nerve damage that includes bilateral carpal release and a right ulnar nerve transposition.”  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 - 20060718	VARD - 20071120	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Cervical Fusion	5241	10%	Degenerative Disc Disease, Cervical Spine	5243	30%	20070619	
Right Cubital Tunnel Syndrome	Not Unfitting	Right Carpal Tunnel and Cubital Tunnel Syndromes 	8512	0%	20070619	
Bilateral Carpal Tunnel Syndrome	Not Unfitting
	Left Carpal Tunnel Syndrome 	8512	0%	20070619	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Cervical Fusion.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s neck condition began in March 2005 following a motor vehicle accident.  He underwent C4-7 anterior cervical discectomy and fusion on 18 July 2005.  The 3 April 2006 MEB physical therapy examination, 5 months prior to separation, noted complaints of constant neck pain.  Physical examination revealed cervical tenderness and guarding of neck movements.  Range of motion (ROM) showed flexion of 10 degrees (normal 45) and combined ROM of 75 degrees (normal 340).  The 8 May 2006 MEB NARSUM examination, 4 months prior to separation, noted complaints of persistent neck pain following surgery.  Physical examination showed significant limitation of motion of the neck.  Testing for radicular pain was negative.  Upper extremity strength, sensation, and deep tendon reflexes were intact.  

At the 19 June 2007 VA Compensation and Pension (C&P) examination, 9 months after separation, the CI reported persistent neck pain between 5 and 8 on a scale of 10.  Physical examination revealed marked resistance to movement.  The ROM study showed flexion of less than 5 degrees and combined ROM of approximately 110 degrees.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the neck condition 10%, coded 5241 (spinal fusion), citing localized tenderness and ROM limited by pain.  The VA rated the neck condition 30%, coded 5243 (intervertebral disc syndrome), based on the C&P examination, citing marked resistance to movement with less than 5 degrees of flexion and pain at all points of rotation.  The panel agreed that a 30% rating was justified for limitation of flexion not greater than 15 degrees as reported on the MEB physical therapy and C&P examinations.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 30% for the neck condition, coded 5241.  

Contended PEB Conditions:  Right Cubital Tunnel Syndrome and Bilateral Carpal Tunnel Syndrome.  The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting.  Neither of the conditions were implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that either of the conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions, so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the neck condition, the panel recommends a disability rating of 30%, coded 5241 IAW VASRD §4.71a.  In the matter of the contended right cubital tunnel and bilateral carpal tunnel syndromes, the panel recommends no change from the PEB determinations as not unfitting.  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	
Cervical fusion	5241	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170304, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR20180008647, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX

I accept the recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) to re-characterize your separation as a disability retirement with the combined disability rating of 30% effective the date of your medical separation for disability with severance pay.  Enclosed is a copy of the Board’s recommendation and record of proceedings for your information.

	The re-characterization of your separation as a disability retirement will result in an adjustment to your pay providing retirement pay from the date of your original medical separation minus the amount of severance pay you were previously paid at separation.
 
	The accepted DoD PDBR recommendation has been forwarded to the Army Physical Disability Agency for required correction of records and then to the U.S. Defense Finance and Accounting Service to make the necessary adjustment to your pay and allowances.  These agencies will provide you with official notification by mail as soon as the directed corrections have been made and will provide information on your retirement benefits.  Due to the large number of cases in process, please be advised that it may be several months before you receive notification that the corrections are completed and pay adjusted.  Inquiry concerning your correction of records should be addressed to the U.S. Army Physical Disability Agency, (AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557.

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

Sincerely,					      
Enclosure