RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-04900
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070406

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a National Guard E7, Military Policeman, medically separated for “neck pain” with a disability rating of 20%.  

CI CONTENTION:  Review all conditions.  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 - 20070221	VARD – 20070907 AND 20080618	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Neck Pain	5241	20%	Intervertebral Disc Syndrome 	5010-5243	20%	20070508	
Left Shoulder Pain	Not Unfitting	Osteoarthritis, Left Shoulder 	5201	10%	20070508	
Hyperlipidemia	Not Unfitting 	No VA Placement	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:  

Neck Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI reported onset of neck pain after a blow to the head while unloading duffel bags in October 2005.  This was associated with left upper extremity (LUE) radicular symptoms and an MRI demonstrated disc herniations (C5/6 and C4/5 with left neural compromise).  He underwent surgery (discectomies and graft fusion) on 26 April 2006 (11 months before separation).  Post-operative STR entries documented an uncomplicated course and improved symptoms, with near resolution of the LUE radicular symptoms (intermittent distal paresthesias only), and multiple neurological examinations were normal.  There was ample STR documentation of improving range of motion (ROM) after the surgery, and final physical therapy (PT) notes recorded only “minimal” ROM limitation in some planes.  There were no post-operative STR entries that documented more significant ROM limitation, abnormal gait or spinal contour, incapacitating episodes, or other VASRD-ratable findings.  

The 13 December 2006 MEB NARSUM examination, 4 months prior to separation, documented persistent neck pain “4 to 5 hours per day” that was rated 4-5/10 and increased “with running, walking long distances and suddenly turning his head.”  The examiner stated that the radiculopathy was “resolved” with no more radiating pain.  The physical examination recorded no spasm or tenderness and normal neurological findings (strength, sensory and reflexes).  The NARSUM incorporated ROM measurements by PT from 6 weeks earlier (27 October).  The PT examiner documented flexion to 30 degrees (normal 45) and combined ROM of 185 degrees (normal 340), opining that limitations were mechanical (versus pain-limited).  

At the 8 May 2007 VA Compensation and Pension (C&P) examination, 1 month after separation, the CI reported “constant” neck pain rated 7/10 with LUE radiation.  The only functional limitation specified was “difficulty turning the head from side to side” and the CI denied any incapacitation.  The physical examination recorded tenderness without spasm, a normal gait and spinal contour and normal neurological findings except for an LUE “sensory deficit” opined to be “peripheral” (specifying the musculocutaneous nerve, not a spinal nerve root).  Measured ROM was flexion to 30 degrees and combined ROM of 240 degrees, specifying pain at end ranges but no ROM degradation with repetition.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the cervical condition 20%, coded 5241 (spinal fusion), citing the PT ROM evidence.  The VA also rated the condition 20%, coded 5010-5243 (traumatic arthritis and intervertebral disc syndrome) and citing the applicable VASRD §4.71a spine criterion (as below) for the C&P ROM measurements.  The VA did not confer additional rating for neuropathy.  The panel agreed that a 20% rating, but no higher, was justified for limitation of cervical flexion (greater than 15 degrees but not greater than 30 degrees), as reported by the service PT and VA examiners.  There was no evidence for incapacitating episodes, which would provide for a higher rating under that formula.  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 cervical spine condition.  

Contended PEB Conditions:  Left Shoulder and Hyperlipidemia.  It was first established that hyperlipidemia is an asymptomatic laboratory finding with no link to fitness.  It is not subject to VASRD rating and will not be addressed further.  Both the service and VA evidence indicated that the CI had suffered a pre-existing injury to his non-dominant left shoulder, a labral tear dating to 1995 (no surgery).  The time of onset or cause for an exacerbation of shoulder pain after mobilization to active duty was not clear from the record, and was clouded by an overlay of the LUE radicular symptoms.  Other than modest ROM limitation and mild painful motion, there was no service evidence for positive physical findings.  The NARSUM documented the pre-service history and stated only, “The left shoulder injury still causes difficulty doing push-ups or swimming.”  The condition was forwarded to the PEB as meeting retention standards and it was not specifically implicated in the commander’s performance statement.  It was, however, listed on the permanent U3 profile at separation.  Although it may have contributed to some limitations (prohibiting Kevlar, body armor, backpack and other general soldiering requirements), there were no profile restrictions or other documented performance limitations specific to the non-dominant shoulder other than those mentioned in the NARSUM.  

Although the PEB fitness adjudication was predicated on the above evidence, the CI underwent arthroscopic surgical repair of the shoulder by the service on 26 February 2007 (6 weeks before separation).  A post-operative note of 16 March (3 weeks before separation) documented “mild” pain and stated that the CI “has noted an increase in the level of function during activities [and] is working, performing all regular duties.”  The only functional limitation specified in the C&P examination (a month after separation as above) was “difficulty with over-head lifting.”  Other than minimal ROM limitations with pain at end-ranges, the physical examination was normal.  

The panel’s main charge is to assess the fairness of the PEB’s determination that the left shoulder condition was not unfitting.  Although the condition was profiled, there was no specific evidence that it, in itself, prohibited any physical requirements critical to the CI’s military police specialty.  This conclusion was supported by the MEB opinion that it did not fail retention standards, as well as the fact that it was not mentioned by the commander.  The shoulder condition may have contributed to some performance limitations; but, members agreed that it would be overly speculative to conclude that any such contributions, alone or by combined effect, would have forced medical separation.  Furthermore, the performance evidence by the time of separation was even more favorable to retention as elaborated above.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determinations for the hyperlipidemia or left shoulder condition, so no additional disability ratings are recommended.  

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 contended hyperlipidemia and left shoulder condition, 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.  Therefore, the panel recommends there be no modification or re-characterization of the CI’s disability and separation determination.  

XXXXXXXXXX. 

XXXXXXXXXX
XXXXXXXXXX
XXXXXXXXXX

Dear XXXXXXXX:

	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