RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03288
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20091005

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Basic Trainee, medically separated for “cervical degenerative disc disease” with a disability rating of 10%.

CI CONTENTION:  “Spinal cord injury C5-C6 infusion.”  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 - 20090901	VARD - 20100121	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Cervical Degenerative Disc Disease	5242	10%	Cervical Spine Intervertebral Disc Syndrome	5243	20%	20091013	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:

Cervical Degenerative Disc Disease.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI injured her neck from a fall in basic training in October 2008.  Imaging demonstrated a C5/6 protrusion with neural impingement which resulted in a C5/6 discectomy and fusion in May 2009.  Post-operative STR entries indicated a favorable course with improving symptoms, but inadequate for a timely full recovery and resumption of training.  Post-operative STR entries documented modestly limited to grossly normal range of motion (ROM) and painful motion.  Formal goniometric ROM measurements for the MEB by physical therapy (PT) on 8 July 2009, documented flexion to 40 degrees (normal 45) with a combined ROM of 300 degrees (normal 340).  The examiner specified that the measurements were performed after three repetitions in each plane, but did not address painful motion.  Remaining treatment notes documented normal gait and spinal contour with no incapacitating episodes or any significant ROM limitations after surgical recovery.  

The 28 July 2009 MEB NARSUM examination, 2 months prior to separation, noted that “overall patient is doing much better” with constant pain rated 2-3/10 and worsened “somewhat with repetitive overhead reaching, lifting, activities of daily living and repetitive neck movement.”  The physical examination recorded “mild” tenderness without spasm or abnormal spinal contour, “guarded [but] full” ROM and normal neurological findings.  

A PT note on 27 August 2009 documented ROM that was 90% of normal in all planes.  An orthopedic entry a few days later documented “guarded … extension,” without commenting on specific ROM limitation (if any).

At the 13 October 2009 VA Compensation and Pension (C&P) examination, 8 days after separation, the CI rated her pain as “moderate” and the only functional limitation cited was “impaired lifting.”  The physical examination recorded tenderness and spasm without note of abnormal contour, and normal neurological findings.  Measured ROM was flexion to 30 degrees with a combined ROM of 230 degrees, and painful motion.  The rated measurements reflected 5-10 degree reductions with repetition in all planes, incorporating DeLuca deductions which were supported by documentation of before and after measurements.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the cervical condition 10%, coded 5242 (degenerative arthritis of spine), citing MEB PT ROM measurements.  The VA rated the cervical condition 20%, coded 5243 (intervertebral disc syndrome), based on the C&P examination, citing flexion of 30 degrees.  Members noted there was no abnormal contour, incapacitating episodes, or other criterion in evidence that would justify a rating higher than 10% based on any §4.71a criteria other than ROM.  However, there was competing ROM evidence, and the panel deliberated the probative value of the conflicting evaluations.  Members concluded that the preponderance of evidence was better aligned with the service ROM measurements.  All of the post-operative ROM evidence corroborated the MEB PT measurements, which were also corroborated by the NARSUM and STR entries in the interval between the NARSUM and separation.  The MEB PT measurements were derived after repetitions, and were thus equivalent to the C&P measurements with regard to DeLuca considerations.  The panel thus agreed that the single flexion measurement by the C&P examiner, only slightly closer to separation than the service evidence, was not sufficient to carry the determinant probative value for the panel’s recommendation.  Members adjudged that a 10% rating, but no higher, was justified for limitation of flexion (greater 30 degrees but not greater than 40 degrees), as recorded by the MEB PT, NARSUM, and multiple other service examiners.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication of the cervical condition.

BOARD FINDINGS:  In the matter of the cervical degenerative disc disease 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:

Exhibit A.  DD Form 294, dated 20170331, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR20180010950, 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.

Sincerely,					      
Enclosure