RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX 	CASE:  PD-2017-03261
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050626

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Petroleum Supply Specialist, medically separated for “chronic pain, neck and left shoulder,” with a disability rating of 10%. 

CI CONTENTION:  She should have been able to retire.  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 - 20050517	VARD - 20060503	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain, Neck and Left Shoulder	5299-5242	10%	Degenerative Disc Disease, Cervical Spine	5242	10%	20051129	
			Neuropathy, Left Upper Extremity	8610	NSC	20051129	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20% 	

ANALYSIS SUMMARY:  

Chronic Pain, Neck and Left Shoulder.  The PEB combined the neck and left shoulder conditions under a single disability rating, coded 5299-5242 and rated 10%.  This approach by the PEB reflected its judgment that the constellation of conditions was unfitting, and there was no need for separate fitness adjudications.  The panel’s initial charge in this case was therefore directed at determining if combining conditions under a single rating was justified in lieu of separate ratings.  When considering a separate rating for each condition, the panel considers each bundled condition to be reasonably justified as separately unfitting unless a preponderance of evidence indicates the condition would not cause the member to be referred into the DES or be found unfit because of physical disability.  When the panel recommends separate fitness recommendations in this circumstance, its recommendations may not produce a lower combined rating than that of the PEB.  The evidence for the neck and left shoulder conditions is presented together, with attendant recommendations regarding separate unfitness, and separate rating if indicated. 

According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s neck and posterior left shoulder pain date back to approximately 1996 after falling off a truck.  X‑rays in May 2004 showed straightening of the normal cervical lordosis and degenerative disc disease from C4 to T1.  An MRI in September 2004 showed a C5-C6 disc-osteophyte complex with mass effect upon the thecal sac, spinal cord and nerve roots.  However, electrodiagnostic studies in January 2005 were normal. 

A neurosurgery examination on 10 February 2005 showed normal strength, sensation, reflexes and range of motion (ROM) of the left arm.  The left upper extremity radicular symptoms had resolved and the examiner was doubtful surgery would resolve the neck pain.

During 25 February 2005 MEB examination (recorded on DD Forms 2807-1 and 2808), 4 months prior to separation, the CI reported numbness in the left arm that radiated from the neck.  Physical examination showed cervical tenderness and crepitus with ROM.  The examiner noted slight decreased sensation in the CI’s left hand (subjective) with an otherwise normal neurological examination and the upper extremity examination was noted as normal.  

The 11 April 2005 MEB NARSUM examination, 3 months prior to separation, noted complaints of neck pain and intermittent left upper extremity radicular symptoms.  Physical examination showed mild tenderness over the cervical spine.  The ROM evaluation showed cervical flexion of 45 degrees (normal) and combined ROM of 340 degrees (normal), with end-range pain during left rotation and lateral flexion.  “The neurological examination was grossly non-focal.”  Shoulder range of motion was not addressed.  

At the 29 November 2005 VA Compensation and Pension (C&P) examination, 5 months after separation, the CI reported neck pain, weakness, tenderness and spasm.  Driving aggravated her condition.  Physical examination showed normal posture, gait and upper extremity reflexes.  The ROM evaluation showed cervical flexion of 45 degrees (after rounding) and combined ROM of 295 degrees (after rounding). The examiner noted that the neck pain radiated into the back and not the arms and that the musculoskeletal examination was otherwise normal

The panel first considered if the left shoulder condition, having been de-coupled from the combined PEB adjudication, remained separately unfitting as established above.  The panel could not find evidence in the commander’s statement or elsewhere in the STR that indicated any significant interference of the left shoulder condition with the performance of duties, nor were any physical findings documented by the MEB or VA examiners which would logically be associated with significant disability.  There was no radiographic evidence of left shoulder pathology because there was never a need to conduct radiographic studies.  The STR showed the main problem in regards to the left shoulder was intermittent radicular pain, which the panel noted had resolved according to the NARSUM.  The panel noted that the cervical degenerative disk disease condition was profiled, implicated in the commander’s statement, and judged to fail retention standards.  Panel members agreed that the neck pain due to cervical degenerative disk disease could be reasonably justified as separately unfitting and that the preponderance of the evidence did not support a separately unfitting determination for the left shoulder condition.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the neck and left shoulder condition 10%, analogously coded 5299-5242 (degenerative arthritis of the spine), citing combined cervical ROM greater than 335 with tenderness.  The VA rated the neck condition 10%, coded 5242, based on the C&P examination, citing combined ROM of the cervical spine greater than 170 degrees, but not greater than 335 degrees.  The VA did not service-connect the left shoulder condition.  

The panel agreed that a 10% rating, but no higher, was justified for a combined ROM of the cervical spine greater than 170 degrees but not greater than 335 degrees, as reported on the NARSUM examination.  There was no muscle spasm or guarding severe enough to result in an abnormal spinal contour to support a 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 the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that separately rating the neck and shoulder conditions would not have resulted in a rating higher than the combined PEB rating; therefore, there was insufficient cause to recommend a change in the PEB adjudication for the neck and shoulder condition.  

BOARD FINDINGS:  In the matter of the neck and shoulder 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:

AR20180015324, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	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.

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Enclosure