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AF | PDBR | CY2012 | PD 2012 01494
Original file (PD 2012 01494.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXX  CASE: PD-2012-01494
BRANCH OF SERVICE: Army  BOARD DATE: 20141003
SEPARATION DATE: 20040130


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was a Reserve SSG/E-6 (33W/Electronic Warfare/Intercept Systems Repairer) medically separated for chronic musculoskeletal pain. The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS), with a profile allowing for modified sit-ups as indicated. He was issued a permanent U3 profile and referred for a Medical Evaluation Board (MEB). The chronic musculoskeletal pain involving the shoulders, arms and left leg condition characterized as “post-traumatic cervical radiculopathy; cervicalgia,” was the only condition forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. The Informal PEB adjudicated “chronic musculoskeletal pain involving the shoulders, arms and left leg condition” as unfitting, rated 10% with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD). The CI made no appeals and was medically separated.


CI CONTENTION: The CI elaborated no specific contention in his application.


SCOPE OF REVIEW: The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e.(2). It is limited to those conditions determined by the PEB to be unfitting for continued military service and those conditions identified but not determined to be unfitting by the PEB when specifically requested by the CI. The rating for the unfitting cervical condition is addressed below. The PEB referenced extremity complaints will also be evaluated to determine if any separately unfitting and ratable conditions were subsumed in the PEB determination. Any conditions or contention not requested in this application, or otherwise outside the Board’s defined scope of review, remain eligible for future consideration by the Board for Correction of Military Records.


 RATING COMPARISON :

Service IPEB – Dated 20031125 VA - (8 Mos. Pre-Separation)
Condition Code Rating Condition Code Rating Exam
Chronic Musculoskeletal Pain (Shoulders, Arms, Left Leg)
5237
 10% Cervical Radiculopathy, Left Side with Diffuse Hyper-Reflexia
8512-5243
 10% 20040507
Other x 0 (Not in Scope) Other x 0 20040507
Combined: 10% Combined: 10%
Derived from VA Rating Decision (VA RD ) dated 20070721 ( most proximate to date of separation [ DOS ] ).


ANALYSIS SUMMARY: The PEB combined the shoulders, arms, and left leg pain as the single unfitting and solely rated condition, coded 5237 (lumbosacral or cervical strain). Although this approach complies with AR 635.40 (B.24 f.); the Board must apply separate codes and ratings in its recommendations, if compensable ratings for each condition are achieved IAW VASRD §4.71a. If the Board judges that two or more separate ratings are warranted in such cases, however, it must satisfy the requirement that each “unbundled” condition was unfitting in and of itself. Not uncommonly this approach by the PEB reflects its judgment that the constellation of conditions was unfitting; and, that there was no need for separate fitness adjudications; not a judgment that each condition was independently unfitting. Thus the Board must exercise the prerogative of separate fitness recommendations in this circumstance, with the caveat that its recommendations may not produce a lower combined rating than that of the PEB. The Board’s analysis and recommendations regarding the separate fitness issue and potential separate rating for each condition entrained in the PEB’s combined rating approach is as follows.

Chronic Musculoskeletal Pain Involving the Shoulders, Arms and Left Leg. Prior to enlistment the CI was involved in an elevator fall with an abrupt stop at the end of the shaft. The incident caused him neck, shoulder and bilateral arm pain with occasional pain into his left leg. Original radiology exams were normal and repeated electro-diagnostic studies of the cervical spine suggested a radiculopathy. He underwent a host of conservative treatment modalities to include local anesthesia injections. He became completely pain free from 1997 until 2003; when he was activated for a deployment. Upon lifting a heavy duffle bag out of a car, he reported a return of prior symptoms to include neck, left shoulder/arm and lateral thigh pain and spasms. A final electro-diagnostic study performed on 15 July 2003 revealed left sided cervical spine denervation (nerve deterioration) at the C6-C7 nerve distribution. The neurologist stated, “the physical examination (PE) was essentially normal, with no myelopathy, radiculopathy, upper motor neuron, or lower motor neuron signs and symptoms.” The CI’s diagnosis was cervical radicular pain syndrome post-trauma. The MEB neurology narrative summary of 3 August 2003, (6 months prior to separation) provided a detailed and chronological history of the CI’s condition. There was no endorsement of current symptoms. The PE revealed full cervical range-of-motion (ROM) without comment regarding painful motion. Tenderness was present in the neck and across upper back muscles. Strength, sensory and motor activity was normal or intact. There was no atrophy present and gait was normal. His diagnosis remained as post-traumatic cervical radiculopathy; cervicalgia (neck pain). The commander’s statement was detailed and included, “[The CI] would be unable to perform most of his duties without moderate to severe pain while symptoms are present.” His profiled diagnosis was traumatic cervical radiculopathy and his restrictions were limited and modified. The VA general spinal and neurology Compensation and Pension examinations were both performed on 7 May 2004 (3 months after separation). Between both examinations, the CI endorsed a sharp neck pain radiating into both upper and lower extremities and aggravated by job stress and fatigue. He reported his symptoms as “variable” in relation to severity, intensity, frequency and duration. Additionally, he reported abnormal sensation and or pain in his left upper arm, left hand (3rd and 4th fingers), left buttocks and leg. The PE revealed normal, but painful cervical and thoracolumbar ROM and a normal gait. There was no spasm, guarding, or atrophy present. Repeat nerve conduction studies were consistent with a C5-C7 left radiculopathy and radiology exams consistently revealed no nerve root compression in the cervical spine. The neurology specific examination additionally revealed increased motor tone in the lower extremities; left greater than right, as well as abnormal plantar (bottom of the foot) reflexes in both feet. The reflexes were described as “mute” with impaired findings on the right foot.

The Board directs attention to its rating recommendation based on the above evidence. The PEB and VA chose different coding options for the condition, but each had the same 10% rating outcome. The Board notes the PEB rated the condition with only a musculoskeletal code, IAW 4.71a, yet the VA rated the condition with an accompanying nerve code as well IAW 4.124a. Board members first agreed that sufficient evidence of cervical painful motion was present to justify the rating of 10% IAW VASRD §4.59, as well as the presence of localized tenderness not resulting in abnormal gait or spinal contour IAW §4.71a. The Board then acknowledged that the chronic radiating neck, shoulder, and arm pain, identified by the PEB as the unfitting condition, was consistently diagnosed as cervical radiculitis (nerve inflammation causing pain along a sensory distribution) and or radiculopathy (referring to disease of the spinal nerve roots; i.e. close to the spinal cord) in the service treatment record and later in the VA exam based not only on the presenting symptoms, but also on the repeated abnormalities on electro-diagnostic tests that identified fasciculations (rapid wave pattern) that were simply suggestive of a radiculopathy. Board members considered if the shoulders and arm pain warranted additional Service disability ratings and concluded that the requisite link of the radiculopathy with functional impairment was not in evidence and, the Board cannot support a recommendation for an additional disability rating on that basis. The pain component of a radiculopathy is subsumed under the general spine rating as specified in §4.71a and noted above.

Left Leg Pain. The left leg pain was reported as a residual condition from both his original and subsequent injury. This condition was not profiled, implicated in the commander’s statement, or noted as failing retention standards. The condition was reviewed by the action officer and considered by the Board. There was no indication from the record that the presence of left leg pain significantly interfered with satisfactory performance of his MOS duty requirements. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that this condition could not be recommended for additional disability rating.


BOARD FINDINGS: IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB will not be considered by the Board to the extent they were inconsistent with the VASRD in effect at the time of the adjudication. The Board did not surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD were exercised. In the matter of the chronic musculoskeletal pain condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication. There were no other conditions within the Board’s scope of review for consideration.


RECOMMENDATION: The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination.


Exhibit A. DD Form 294, dated 20120814, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record








                 
XXXXXXXXXXXXXXXXX
President
Physical Disability Board of Review



 SAMR-RB                                                                         


MEMORANDUM FOR Commander, US Army Physical Disability Agency
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557


 SUBJECT: Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXXXX , AR20150002623 (PD201201494)

I have reviewed the enclosed Department of Defense Physical Disability Board of Review (DoD PDBR) recommendation and record of proceedings pertaining to the subject individual. Under the authority of Title 10, United States Code, section 1554a, I accept the Board’s recommendation and hereby deny the individual’s application.
This decision is final. The individual concerned, counsel (if any), and any Members of Congress who have shown interest in this application have been notified of this decision by mail.

BY ORDER OF THE SECRETARY OF THE ARMY:

Encl                                                  XXXXXXXXXXXXXXXXX
                                                      Deputy Assistant Secretary of the Army
                                                      (Review Boards)
                                                     
CF:
( ) DoD PDBR
( ) DVA

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