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AF | PDBR | CY2012 | PD2012 01381
Original file (PD2012 01381.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: xx         CASE: PD1201381
BRANCH OF SERVICE: MARINE CORPS  BOARD DATE: 20130530
SEPARATION DATE: 20011015


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty LCPL/E-3 (0800/Trainee for General Artilleryman) medically separated for his cervical spine condition. The CIs neck and low back pain (LBP) with upper and lower extremity complaints started in October 2000 during recruit training. The CI was offered but declined surgery. The neck and back pain could not be adequately rehabilitated to meet the physical requirements of the Military Occupational Specialty he was training for or satisfy physical fitness standards. He was placed on limited duty and referred for a Medical Evaluation Board (MEB). The neck and low back conditions, characterized as “herniated disc and spondylosis, c-spine” and “chronic low back pain,” were forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E. No other conditions were submitted by the MEB. The PEB adjudicated “herniated disk and spondylosis in cervical spine” as unfitting, rated 10%. The remaining condition , chronic LBP , w as determined to be a Category III condition, ( n ot separately u nfit ting and do es not contribute to the unfitting condition ). 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 spine condition is addressed below; no additional conditions are within the DoDI 6040.44 defined purview of the Board. The low back condition, identified as not unfitting by the PEB, was not requested for review and thus is not within the defined scope. 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 Naval Records.


RATING COMPARISON:

Service IPEB – Dated 20010821
 VA - (7 Mos. Post-Separation) Effective 20011016
Condition
 Code Rating Condition Code Rating Exam
C Spine Herniated Disk and Spondylosis
 5293 10% Cervical DDD w/Chronic Radiculopathy 5010-5293 60% 20020509
Chronic Low Back Pain
 CAT III No Corresponding VA Entry
No Additional MEB/PEB Entries
 Other x 4 20020509
Combined: 10%
 Combined: 70%
Derived from VA Rating Decision (VA RD ) dated 200 20 528 and 200208 27 ( most proximate to date of separation [ DOS ] ).



ANALYSIS SUMMARY:

Herniated Disk and Spondylosis in Cervical Spine. The narrative summary (NARSUM) notes that the CI reported neck pain that began in October 2000 during basic training. Service treatment records (STR) indicated the CI related the neck pain to lifting and carrying heavy sacks and equipment during boot camp. Cervical magnetic resonance imaging in January 2001 showed degenerative disc disease with bulging discs at C3-C7, without evidence of spinal canal stenosis or nerve impingement. The CI was evaluated by a neurologist who noted a “bulging disc abuts the spinal cord” and referred him to a neurosurgeon for “radiculomyelopathy” (symptoms from both nerve and spinal cord compression). The neurosurgical evaluation on 8 January 2001 noted restricted cervical range-of-motion (ROM) and tenderness of the right shoulder muscles without any sensory or motor deficits and prescribed physical therapy. According to the NARSUM the CI was not considered a surgical candidate, but notes in the STR indicated that the CI was offered the option of surgery by the neurosurgeon but declined and chose conservative treatment instead. The CI had 8 weeks of physical therapy with improved but still restricted and painful neck ROM. The final neurosurgical evaluation on 16 March 2001, approximately 7 months prior to separation, showed cervical ROM was “slightly restricted” and “mild tenderness on palpation of the right trapezius and deltoid muscles,” without any motor or sensory deficits. At the MEB exam on 16 May 2001, approximately 5 months prior to separation, the CI reported constant pain in his neck that radiated to his right arm and some numbness of the right hand with occasional problems dropping things. The MEB physical examination performed on 16 May 2001, approximately 5 months prior to separation noted that the neck had decreased ROM, with extension more limited than flexion. There was full rotational ROM but with pain. There was tenderness to palpation of the lower cervical spine. Strength was slightly decreased on the right compared with the left, with a decreased hand grip on the right. Sensation was intact and reflexes were symmetrical.

At the VA Compensation and Pension examination performed on 9 May 2002, approximately 7 months after separation, the CI reported neck, shoulder, and hand grip problems. He reported right hand numbness and losing his grip occasionally, and dropping things. The numbness was described as being on the inside of the right arm. He reported neck, right shoulder and right arm pain, more than on the left. The VA exam showed “markedly” limited ROM with spasm of the paraspinal muscles. Reflexes in the arms were symmetrical, with decreased biceps and brachioradialis reflexes and absent triceps reflexes. Sensation was decreased in the C7 distribution of the right arm and strength was limited by pain.

The Board directs attention to its rating recommendation based on the above evidence. The PEB rated the neck condition as 5293 (intervertebral disc syndrome) at 10%. The VA rated as 5010-5293 (analogous to intervertebral disc syndrome/traumatic arthritis) at 60%. The Board agreed the CI’s neck condition met the 20% rating coded as either 5290 (limitation of cervical motion) or 5293 and deliberated to determine if a higher evaluation of was achievable. At both the MEB and May 2002 VA exams the CI reported neck and right arm pain and numbness of the right arm with occasional problems dropping things; both exams showed decreased, painful cervical ROM with mildly decreased right hand strength noted, with decreased sensation also noted in the VA exam. Evaluations in the STR noted mild to marked decreased cervical ROM with muscles tender to palpation or in spasm and intermittently noted decreased sensation and weakness of the right hand. The Board opined that the CI’s neck pain condition most nearly met the 20% rating coded as 5293 IAW the Veterans Affairs Schedule for Rating Disabilities (VASRD) §4.71a. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (Reasonable doubt), the Board recommends a disability rating of 20% for the neck pain condition.


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 neck pain condition, the Board unanimously recommends a disability rating of 20%, coded 5293 IAW VASRD §4.71a. There were no other conditions within the Board’s scope of review for consideration.


RECOMMENDATION: The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation:

UNFITTING CONDITION
 VASRD CODE RATING
Cervical Spine Herniated Disk and Spondylosis Condition
 5293 20%
COMBINED
 20%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20120614, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record





         xx
         President
         Physical Disability Board of Review


 MEMORANDUM FOR DEPUTY COMMANDANT, MANPOWER & RESERVE AFFAIRS
          COMMANDER, NAVY PERSONNEL COMMAND
                                          
Subj: PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS

Ref: (a) DoDI 6040.44
(b) PDBR ltr dtd 9 Aug 13 ICO
(c) PDBR ltr dtd 17 Jul 13 ICO
(d) PDBR ltr dtd 16 Jul 13 ICO
(e) PDBR ltr dtd 9 Aug 13 ICO
(f) PDBR ltr dtd 9 Aug 13 ICO
(g) PDBR ltr dtd 29 Jul 13 ICO
(h) PDBR ltr dtd 8 Aug 13 ICO

1. Pursuant to reference (a) I approve the recommendations of the Physical Disability Board of Review set forth in references (b) through (h).

2. The official records of the following individuals are to be corrected to reflect the stated disposition:

a. former USMC : Disability separation with a final disability rating of 20 percent (increased from ten percent) effective 15 October 2001.

b. former USN : Disability retirement with assignment to the Permanent Disability Retired List with a 40 percent disability rating (increased from 20 percent) effective 2 May 2003.

c. former USN : Disability retirement with assignment to the Permanent Disability Retired List with a 30 percent disability rating (increased from 20 percent) effective 2 June 2009.

d. former USN : Disability separation with a final disability rating of 20 percent increased from ten percent) effective 5 October 2004.

e. former USMC : Disability separation with a final disability rating of 20 percent (increased from ten percent) effective 31 July 2002.

f. former USMC : Disability separation with a final disability rating of 20 percent (increased from ten percent) effective 1 August 2005.

g. former USMC : Disability separation with a final disability rating of 20 percent (increased from ten percent) effective 2 July 2002.
        
3. Please ensure all necessary actions are taken, included the recoupment of disability severance pay if warranted, to implement these decisions and that subject members are notified once those actions are completed.

xx
                                                      Assistant General Counsel
                                                      (Manpower & Reserve Affairs)

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