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AF | PDBR | CY2013 | PD-2013-02277
Original file (PD-2013-02277.rtf) Auto-classification: Approved
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXX         CASE: PD-2013-02277
BRANCH OF SERVICE: Army  BOARD DATE: 20141113
SEPARATION DATE: 20060109


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated National Guard SFC/E-7 (25W/Communication Platoon Sergeant) medically separated for right vocal cord paralysis, a neck problem, a left shoulder problem, and coronary artery disease (CAD). These conditions could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards. The CI was referred for a Medical Evaluation Board (MEB). The MEB forward “coronary artery disease with angina” conditions to Physical Evaluation Board (PEB) as not meeting retention standards, IAW AR 40-501. The MEB also forwarded “hypertension; controlled, (Non-boardable” and “lymphadenopathy; NOS” to the PEB. The Informal PEB (IPEB) determined that the “symptoms coronary artery disease with exertional angina” as “pre-existing hypertensive cardiovascular disease is following its natural aggravated by active service,” rated at ---%. The CI non-concurred with the IPEB findings and recommendation, thus requested and was granted Formal PEB (FPEB). The FPEB reaffirmed the IPEB findings; however these proceeding were cancelled for further medical evaluation. He was issued a permanent P4/U3/L3 profile and his case file was re-submitted for an MEB. The secondary MEB forward “numbness in the left hand”, “non-radicular pain involving the cervical spine”, “left shoulder pain”, “obstructive sleep apnea; mild”, “total paralysis of the right vocal cord”, and “coronary artery disease associated with angina,” conditions to IPEB as not meeting retention standards, IAW AR 40-501. The IPEB adjudicated the “right vocal cord paralysis,” “chronic radiation neck and stiffness with symptoms of shoulder pain and left had paresthesias…,” and “chronic left shoulder pain with onset after an Anthrax immunization,” as unfitting, rated at 10%, 0%, 0% and the “coronary artery disease (CAD)”was the “natural progression of a pre-existing condition and do not constitute permanent service aggravation,” rated as ---%, with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) as well as application of the US Army Physical Disability Agency (USAPDA) pain policy. The IPEB also adjudicated the obstructive sleep apnea (OSA), mild; depression; hypertension; and lymphadenopathy as not unfitting. The CI made no further appeals and was medically separated.


CI CONTENTION: The CI writes: “I came home unable to work. The VA rated me at 80% but unemployable pay at 100%. I am not able to work because of things happened on active duty. Sometimes I can’t talk due to vocal cord paralyzed. I am in constant pain left shoulder and arm. It seems like every day a new symptom from anthrax. Left shoulder and lympnodes causing not to be able to use it. On my PEB they didn’t include my diabetes it happened while on duty. I was supposed to be on their. I didn’t appeal; I was ready to go home. I was told VA could take care and give better rating. You will notice not awarded much from Medical Board.”


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 ratings for the unfitting right vocal cord paralysis; chronic radiating neck pain to include numbness in the left hand; chronic left shoulder pain, and CAD conditions are addressed below. Additionally, the OSA and depression will be reviewed by the Board as they contributed to the 80% rating and were reviewed by the PEB; however, the contended diabetes was not considered by the MEB/PEB and is therefore not within the DoDI 6040.44 defined purview of the Board. 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.

The Board acknowledges the CI’s information regarding the significant impairment with which his service-connected condition continues to burden him; but, must emphasize that the Disability Evaluation System has neither the role nor the authority to compensate members for anticipated future severity or potential complications of conditions resulting in medical separation. That role and authority is granted by Congress to the Department of Veterans Affairs (DVA), operating under a different set of laws. The Board considers DVA evidence proximate to separation in arriving at its recommendations; and, DoDI 6040.44 defines a 12-month interval for special consideration to post-separation evidence. Post-separation evidence is probative to the Board’s recommendations only to the extent that it reasonably reflects the disability at the time of separation.


 RATING COMPARISON :

Service IPEB – Dated 20051205
 VA - (~30 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Right Vocal Cord Paralysis 6516 10% Right Vocal Cord Paralysis 6516 10% 20080716
Chronic Radiating Neck… 5241 0% DDD, C6-7, w/Spondylosis 5243 20% 20080716
Chronic Left Shoulder Pain 5099-5003 0% Frozen Shoulder Syndrome, S/P Anthrax Vaccine 5201 20% 20080716
CAD 7005 ---% CAD, S/P MI and CABG 7017 10% 20080716
Depression Not Unfitting Depression Secondary… 9499-9434 10% 20080724
OSA Not Unfitting Sleep Apnea 6847 50% 20090615
Other x 3 (Not in Scope)
 Other x 1 20080716
Combined: 10%
 Combined: 60%
Derived from VA Rating Decision (VA RD ) dated 200 81011 (most proximate to date of separation )
The VA effective date is 20060110, the day after separation from active duty.


ANALYSIS SUMMARY:

Coronary Artery Disease Condition. Service medical records show, that in 1997, while working in a civilian capacity, the CI began a diagnostic workup for a one-month history of exertional chest pain. While still undergoing evaluation, he presented to a civilian emergency department on 9 November 1997, during a drill weekend, and was diagnosed with a myocardial infarction (MI; heart attack). It was noted that he had the worst pain to date the day prior to his drill weekend. On 11 November 1997, the CI underwent coronary artery bypass graft (CABG) surgery. The CI did well after the procedure and was returned to duty status. There is no evidence in the record that he met either a MEB or PEB for the CAD status post MI and CABG although he was issued a profile for the cardiovascular screening program. The Board noted that a CABG does not treat the underlying disease of arteriosclerosis and that recurrence of disease in the grafts is an expected complication. Re-occlusion can be delayed by aggressive medical management which includes medications, aggressive lifestyle changes (weight loss, diet, and exercise), and cessation of smoking. It does not appear from the record that the CI was successful in lifestyle changes in that the 2001 periodic physical recorded a weight of 264 pounds, well in excess of his maximum. Recurrent disease is, accordingly, not unexpected. The CI was activated on 1 May 2003 for a 365-day tour. The demobilization exam was on 20 May 2004. The CI reported that he had muscle spasms after the second anthrax vaccine absorbed (AVA), but was currently pain free and had a benign exam. However, it was noted that the 68 inch CI weighed 250 pounds. He was released without limitations. Four days later, the CI was seen in primary care and reported ongoing neck and left shoulder pain which started after the second AVA. Because of worsening chest pain, his history of CAD, and shortness of breath with exertion, the CI had a cardiac catheterization. This showed progression of the CAD. On 8 June 2004, he underwent balloon dilation and placement of two coronary artery stents. The 22 June 2004 echocardiogram (heart ultrasound imaging) was unremarkable and showed good heart function. The CI achieved 10.1 metabolic equivalents (METs; resting metabolic rate used to describe functional capacity or exercise tolerance) during a 24 June 2004 nuclear medicine myocardial (heart muscle) perfusion stress test; however, there was a small exercise induced perfusion defect (area of reduced blood flow). Due to symptom persistence, another dilation and stent placement was accomplished on 2 September 2004. At the 20 September 2004 MEB history and physical exam , the cardiolog ist indicated that the CI was not a good candidate for additional procedures and was li kely to continue to have angina . The cardiologist opined that , with aggressive medical therapy , the CI had a good prognosis. The CI achieved 10.1 METS during 22 September 2004 myocardial perfusion stress test which showed normal heart function, but small exercise induced perfusion defects. The CI achieved 10.4 METS during a 22 October 2004 exercise stress echocardiogram. The 15 November 2004 IPEB noted the longstanding risk factors of obesity, hyperlipidemia, and hypertension. It determined that the pre-existing hypertensive cardiovascular disease was following its natural course and had not been permanently aggravated by service. In a 9 December 2004 memorandum for the MEB, the cardiologist indicated that the CI had a history of stable, asymptomatic CAD prior to being mobilized for active duty. The cardiologist opined that the stresses associated with mobilization could have predisposed the CI to have worsening of his coronary symptoms. The 6 January 2005 FPEB also concluded that the cardiovascular disease was EPTS, had followed its natural course, and had not been permanently aggravated by service. Therefore, no disability rating was assigned. In a 12 January 2005 memorandum for the MEB the cardiologist documented that the CI had developed left arm pain over several months, following receiving the second AVA. The cardiologist did not have a diagnosis for the arm pain and opined that fixing the arm pain may help with the CI’s chest pain and change the permanent profile for his cardiac condition. As noted above, the CI was placed on medical hold for the treatment of non-cardiac conditions. The 17 November 2005 cardiology addendum for the MEB narrative summary (NARSUM) indicated that the CI had persistent angina. The CI was not a candidate for further revascularization, would require aggressive medical therapy to treat his angina, and would require a permanent (P4) profile. The 5 December 2005 IPEB found with regards to the CAD with exertional angina that the recent and present symptoms represented natural progression of a pre-existing condition and did not constitute permanent service aggravation.

The Board’s main charge regarding this condition is evaluation of the PEB determination that the CAD was an EPTS condition. The Board’s authority for recommending a change in the service’s EPTS determination is not specified in DoDI 6040.44, but is considered adjunct to its DoD‐specified obligation to review fitness adjudications. As with its consideration of fitness adjudications, the Board’s threshold for countering service EPTS determinations is higher than the VASRD §4.3 “resolution of reasonable doubt” standard used for its rating recommendations, but remains adherent to the DoDI 6040.44 “fair and equitable” standard. The Board determined that the evidence is clear that this was an EPTS condition. It then considered service aggravation and observed that it is not unusual for individuals with preexisting, but asymptomatic conditions to become symptomatic once they undergo the increased activity and rigors attendant to a military lifestyle. The PEB listed the unfitting CAD (VASRD code 7005; CAD), but assigned no rating as the condition was determined to be EPTS without permanent service aggravation. The Board concurred with this assessment. It also noted that even if the condition was ratable, the disability in evidence would support no more than a 10% rating for the continuous use of medications. At activation, the CI was also on medications for CAD supporting, at a minimum, a 10% deduction. Thus, even if the Board had found service aggravation, the rating after the EPTS deduction would be 0%, providing no advantage to the CI. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the CAD condition.

Chronic Left Shoulder Pain Condition. The CI complained of left neck muscle spasms several hours following his second AVA in the left arm on 1 August 2003. He reported that spasms and radiation of left arm pain had increased over the months, but he was asymptomatic at the 20 May 2004 demobilization exam. Four days later though, he reported 7/10 pain in the neck and left shoulder which was aggravated by use and kept him awake at night. An 11 August 2004 CT scan showed left neck lymphadenopathy (chronic, abnormal enlargement of the lymph nodes). A left supraclavicular lymph node biopsy on 7 October 2004 showed nonspecific, chronic inflammation. An X-ray image of the left shoulder, dated 1 November 2004, showed possible calcification within the biceps tendon (calcific tendonitis). An injection of steroids and local anesthetic provided symptom relief. Electrodiagnostic studies were offered, but the CI declined stating the he would continue the evaluation at home with the VA if he was satisfied with the PEB disability percentage. On 12 and 21 January 2005, magnetic resonance imaging (MRIs) of the left brachial plexus (complex network of nerves innervating chest, shoulder, and arm) showed a normal brachial plexus but left C5-6 disc protrusion contacting the spinal cord which might be the cause of the patient's reported left upper extremity symptoms. A 27 January 2005 left upper extremity electrodiagnostic study was normal. An 18 February 2005 cervical spine MRI showed a left disc protrusion at C6-7 causing stenosis (narrowing) and contacting the spinal cord and left-sided nerve root. At the 2 March 2005 neurology evaluation, the CI described a temporal relationship between his second AVA and the development of severe muscle spasms and swelli ng around the left collarbone. The neurologist referred the CI to neurosurgery for evaluation of the herniated disc . At the 10 March 2005 neurosurgery evaluation, the CI reported he developed arm and neck pain after lifting missiles during an exercise in May 2004. Previously, he had reported that the pain began after the second AVA in August 2003. The CI complained of constant sharp neck pain and radicular pain (radiating following a nerve distribution) on the outer left arm and inner edge of the left shoulder blade. The pain had persisted despite rest and medications. Sensory and motor changes were present on examination. After a course of antibiotics to reduce soft tissue swelling and lymphadenopathy, the CI had a C6-7 cervical fusion on 17 May 2005.

The 30 September 2005 MEB NARSUM by neurosurgery reported the CI’s left shoulder, arm, and hand symptoms had not been significantly improved by his cervical spine operation despite postoperative imaging demonstrating decompression and fusion at the operated level and no residual compressive spinal disease. A focused physical exam showed spasm of back and shoulder musculature was present, worse on the left side. Left shoulder joint tenderness to palpation was present. The diagnosis listed left shoulder pain, etiology uncertain, following reaction to anthrax vaccine. The 21 N ovember 2005 ( 2 months prior to separation) physical therapy (PT) left shoulder range-of-motion (ROM) evaluations were p erformed using a goniometer . The CI was able to raise his arm above the shoulder in both flexion and abduction, but motion was painful. In the 22 November 2005 Vaccine Healthcare Center evaluation, the evaluator noted a temporal relationship did exist between the onset of neck spasms, the anthrax vaccination, and the diagnosis of cervical disc protrusion. The distant onset of chest pain and swelling in relation to the anthrax vaccination made a causal relationship unlikely.

The Board directs its attention to its rating recommendation based on the above evidence. The PEB rated the right shoulder condition 0% (VASRD code 5099-5003; disability rating by analogy-degenerative arthritis) citing normal imaging, slight occasional pain, pain on motion, almost full motion, normal strength, normal, stability, and no muscle atrophy. The VA rated the condition 20% (5201; arm, limitation of motion of) citing ROM relying on the 16 July 2008 VA C&P examination, which was remote from separation. Both painful motion (§4.59) and functional loss (§4.40) support a 10% rating using the PEB 5003 code. Absent a ROM limited to the shoulder level; scapulo-humeral ankylosis; malunion of the humerus, clavicle or scapula; or, dislocation, the Board found no route to a higher rating. The 5201 code provides a better description of the disability, but the ROM loss does not support the minimum compensable rating of 20%. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the chronic left shoulder pain condition using the analogous code 5299-5201.

Chronic Neck Pain Condition. An 18 February 2005 cervical spine MRI showed a left disc protrusion at C6-7 causing stenosis and contacting the spinal cord and left-sided nerve root. The subjective history and objective exam findings from the 10 March 2005 neurosurgery evaluation are documented above under the chronic left shoulder pain condition. The diagnosis was listed as herniated cervical intervertebral disc which required surgery for relief of symptoms. A 9 May 2005 cervical spine X-ray showed no significant radiologic abnormality. On 17 May 2005 the CI underwent a right anterior cervical discectomy and fusion and suffered an injury to his right recurrent laryngeal nerve (innervates muscles of the larynx which control respiration, airway protection, coordination of swallowing, and phonation). At the 20 June 2005 neurosurgery follow-up, the CI complained of continued neck and shoulder pain with left arm weakness in the triceps and tingling in the 4th and 5th digits at night. He reported his voice was soft and hoarse and swallowing was difficult. Cervical spine X-ray showed no migration of the graft or metallic implants with some soft tissue swelling. Diagnoses were listed as dysphonia (impairment of voice), dysphagia (difficulty swallowing), and cervicalgia (neck pain). The neurosurgeon opined that the CI had right recurrent laryngeal nerve palsy (paralysis) which he expected to resolve in 3 to 6 months. The CI was rehabilitated in PT. On 25 July 2005, 2 months after surgery, the ROM was documented as 26 degrees of flexion (rounds to 25) with a combined ROM of 127 degrees (120 after rounding). Tenderness, but not spasm was recorded. A 30 September 2005 cervical spine X-ray images showed unchanged alignment of the hardware and bony structures. The 30 September 2005 MEB NARSUM by neurosurgery reported the CI’s left shoulder, arm, and hand symptoms had not been significantly improved by his cervical spine operation despite postoperative imaging demonstrating decompression and fusion at the operated level and no residual compressive spinal disease. A focused physical exam showed full cervical ROM with pain in all directions. Spasm of back and shoulder (erector and trapezius) musculature were present, worse on the left side. Provocative tests caused no neurological manifestations. Flexion and extension X-ray studies showed no instability. The Board noted that the minimum ROM for the views to be adequate is 30 degrees of flexion and 30 degrees of extension. Tenderness was present with palpation of the left shoulder joint. Strength exam found no abnormalities. Sensorium was diminished to simple touch in small and ring fingers on the left, consistent with ulnar nerve distribution. Reflexes were 0/4 in bilateral biceps and triceps tendons. The diagnoses were listed as numbness in the left hand, etiology uncertain; non-radicular pain involving the cervical spine; and left shoulder pain, etiology uncertain, following reaction to anthrax vaccine. A 14 October 2005 MRI of the cervical spine showed excellent position and alignment of the fixation device and bone graft, congenital spinal canal stenosis, and other discs as normal. The 21 November 2005 ( 2 months prior to separation ) PT exam documented cervical spine ROMs p erformed using a goniometer which are summarized in the chart below . Spasm was not documented nor was there an indication of why the ROM was reduced from previous measurements. The goniometric ROM evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.

Cervical ROM
(Degrees)		 MEB ~4 Mo. Pre-Sep PT ~2 Mo. Pre-Sep VA C&P ~30 Mo. Post-Sep
Flex (45 Normal) FROM 5 30
Combined (340) FROM 110 #
Comment FROM with pain Motions limited by pain L Lat Flexion elicits pain
§4.71a Rating 10% 30% 20%

The Board directs its attention to its rating recommendation based on the above evidence. The 5 December 2005 IPEB rated the chronic radiating neck pain status post diskectomy and fusion at 0% under VASRD code 5241 (spinal fusion) citing full motion without tenderness. The 11 October 2008 VARD rated the degenerative disc disease at 20% under code 5243 (intervertebral disc syndrome) citing ROM. The 16 July 2008 (30 months after separation) VA C&P exam by was well outside the normal 12 month window for higher probative value. Although the PEB and VA used different codes, both codes are rated under the General Rating Formula for Diseases and Injuries of the Spine, based on limitation of cervical ROM. The ROMs in the proximate exams (MEB exam by neurosurgery and PT) differ significantly. The full ROM documented in the MEB exam by neurosurgery (4 months prior to separation) supports no more than a 10% disability rating, including consideration of VASRD §4.59 (painful motion), §4.40 (functional impairment), or §4.45 (Deluca). The Board noted that this is consistent with the ability to accomplish a flexion and extension X-ray exam that same day and the expected progress after surgery which are also seen in the July 2005 PT measurements. The goniometer measured ROM documented in the PT exam (2 months prior to separation) supports a 30% disability rating due to forward flexion of the cervical spine 15 degrees or less. Though inconsistent with the remainder of the record, the PT ROMs were specifically performed for the MEB IAW DoD and VA guidelines using a goniometer. Using §4.7 (higher of two examinations), the Board assigned a higher probative value to the PT ROMs for rating purposes. The Board also considered rating the neck condition using the VASRD formula based on incapacitating episodes due to intervertebral disc syndrome. No documented physician directed bed rest was evident in the service treatment records or at the time of the MEB NARSUM exam. Finally, the Board considered if additional disability rating was justified for peripheral nerve impairment due to radiculopathy. The CI had intervertebral disc disease treated surgically with intermittent reports of radicular symptoms (left neck, shoulder, and arm pain and numbness). The critical decision is whether or not there was significant motor weakness or sensory loss which would impact military occupation specific activities. While the MEB NARSUM exam documented diminished sensation to simple touch consistent with a left ulnar nerve distribution (not secondary to the neck), strength was normal, coordination was intact, reflexes were symmetric, and hyperreflexia was absent. There was no evidence that motor weakness or sensory loss existed to any degree that could be described as functionally impairing and unfitting at separation. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 30% for the chronic neck pain condition, coded 5241.

Right Vocal Cord Paralysis Condition. 0n 17 May 2005 the CI underwent a right anterior cervical discectomy and fusion and suffered an injury to his right recurrent laryngeal nerve. The CI was initially diagnosed with a right recurrent laryngeal nerve neurapraxia (nerve injury that interrupts conduction causing temporary paralysis followed by a complete recovery) with associated dysphonia and dysphagia (difficulty speaking and swallowing). Because the speech and swallowing deficits did not significantly improve following evaluation and interventions by speech pathology, the diagnosis was changed to right recurrent laryngeal nerve palsy (paralysis). A 28 September 2005 endoscopic exam showed no motion in the right true vocal cord during phonation or deep inspiration. The assessment indicated that vocal function was compromised to a nearly non-usable and non-serviceable voice and swallowing dysfunction was managed with special techniques. The diagnosis was listed as total paralysis of right vocal cord.

The Board directs its attention to its rating recommendation based on the above evidence. The 5 December 2005 PEB rated the unfitting right vocal cord paralysis 10% (VASRD code 6516; laryngitis, chronic) citing the endoscopic exam showing no movement and hoarseness with loss of voice projection. The 11 October 2008 VARD rated the right vocal cord paralysis at 10% as code 6516. The 24 July 2008 ENT VA C&P exam (30 months after separation) documented persistent right vocal cord paralysis but was well outside the normal 12 month window for higher probative value. Incomplete aphonia (loss of voice) is evaluated as laryngitis, chronic (6516). A rating of 10% was assigned because there was hoarseness with inflammation of cords or mucous membrane. A higher rating of 30% was not warranted because there was no hoarseness with thickening or nodules of cords, polyps, sub-mucous infiltration, or pre-malignant changes on biopsy. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the right vocal cord paralysis condition.

Contended PEB Conditions.

OSA. The CI was evaluated in the pulmonary clinic on 14 October 2005 for poor sleep and thought to have possible sleep apnea. Mild OSA was diagnosed after a sleep study a week later on 20 October 2005. Two weeks after that on 5 November 2005, he had a trial of nasal continuous positive airway pressure with a good response. The MEB noted that this was a medically unacceptable condition. The OSA condition was profiled. The commander did not note a duty impairment from this condition; rather, that his numerous medical appointments interfered with his duties in the medical hold company. The PEB found the condition to be not-unfitting. The Board notes that while OSA remains medically unacceptable, individuals are routinely returned to duty with this diagnosis. In addition, the level of impairment was mild, in fact, barely past the cut-off for normal variation.

Secondary Depression Condition. The CI was referred to mental health (MH) for depression related to multiple medical problems and separation from his family. At the 1 November 2005 MH evaluation, the diagnosis was listed as mood disorder due to general medical condition. The CI was started on a trial of an antidepressant. The psychiatrist indicated that the CI met retention standards for depression and that he would write an addendum to that effect. In the 7 November 2005 (2 months prior to separation) psychiatric addendum for the MEB, the CI complained of feeling down and depressed for the preceding 6 months. The psychiatrist opined that the CI’s MH issues resulted in no functional limitations. His MH condition was considered medically acceptable and he met retention standards. At the 15 November 2005 MH evaluation, the CI reported improving symptoms of depression since starting (1 November 2005) the antidepressant medication. The 21 November 2005 MEB found that the CI met retention standards for the depression secondary to a general medical condition. The depression was not implicated in the commander’s statement or the permanent physical profile. The 5 December 2005 IPEB found the depression secondary to a general medical condition to be not unfitting and therefore not ratable.

The Board’s main charge is to assess the fairness of the PEB’s determination that the OSA and secondary depression condition were not unfitting. The Board’s threshold for countering fitness determinations is higher than the VASRD §4.3 (reasonable doubt) standard used for its rating recommendations, but remains adherent to the DoDI 6040.44 “fair and equitable” standard. The contended OSA and secondary depression condition were reviewed by the Board. There was no performance based evidence from the record that either condition significantly interfered with satisfactory duty performance. After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for either condition and so no additional disability rating is recommended.


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 . As discussed above, PEB reliance on the USAPDA pain policy for rating the left shoulder condition was operant in this case and the condition was adjudicated independently of that policy by the Board. In the matter of the CAD condition and IAW VASRD §4. 104 , the Board unanimously recommends no change in the PEB adjudication. In the matter of the chronic left shoulder pain condition, the Board unanimously recommends a disability rating of 10 % , coded 5299-5201 IAW VASRD §4. 59 . In the matter of the chronic neck pain condition, the Board unanimously recommends a disability rating of 30 %, coded 5241 IAW VASRD §4.71a. In the matter of the right vocal cord paralysis condition and IAW VASRD §4. 97 , the Board unanimously recommends no change in the PEB adjudication. In the matter of the contended secondary depression and OSA condition s , the Board unanimously recommends no change from the PEB determination as not unfitting. 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; and, that the discharge with severance pay be re-characterized to reflect permanent disability retirement, effective as of the date of his prior medical separation:

UNFITTING CONDITION VASRD CODE RATING
Coronary artery disease 7005 ---
Chronic left shoulder pain 5299-5201 10%
Chronic radiating neck pain and left hand paresthesias 5241 30%
Right vocal cord paralysis 6516 10%
COMBINED 40%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20131021, 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, AR20150005547 (PD201302277)
1. Under the authority of Title 10, United States Code, section 1554(a), I approve the enclosed recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) pertaining to the individual named in the subject line above to recharacterize the individual’s separation as a permanent disability retirement with the combined disability rating of 40% effective the date of the individual’s original medical separation for disability with severance pay.

2. I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum:

         a. Providing a correction to the individual’s separation document showing that the individual was separated by reason of permanent disability retirement effective the date of the original medical separation for disability with severance pay.

         b. Providing orders showing that the individual was retired with permanent disability effective the date of the original medical separation for disability with severance pay.

         c. Adjusting pay and allowances accordingly. Pay and allowance adjustment will account for recoupment of severance pay, and payment of permanent retired pay at 40% effective the date of the original medical separation for disability with severance pay.

         d. Affording the individual the opportunity to elect Survivor Benefit Plan (SBP) and medical TRICARE retiree options.

3. I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

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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    Original file (PD2013 00003.rtf) Auto-classification: Denied

    The Board considered whether an additional rating could be recommended under a peripheral nerve code for cervical radiculopathy. Examination revealed slow and guarded ambulation, normal posture and gait with slight increase in lumbar lordosis, there was paraspinal muscle tenderness and spasm, positive straight leg raising test, pain throughout the thoracolumbar ROM, normal lower extremity motor and sensory examination. SUBJECT: Department of Defense Physical Disability Board of Review...

  • AF | PDBR | CY2014 | PD-2014-01099

    Original file (PD-2014-01099.rtf) Auto-classification: Approved

    Post-Separation)ConditionCodeRatingConditionCodeRatingExam Chronic Bilateral Lower Leg Pains… 5099-50220%Chronic Shin Splints, Right Lower Extremity 5299-52620%20070308Chronic Shin Splints, Left Lower Extremity5299-52620%20070308Adjustment Disorder with Anxious MoodNot UnfittingAdjustment Disorder with Anxious Mood (also Claimed as Anxiety)9435-944030%20070531Personality DisorderNot UnfittingNo Diagnosis20070531Vocal Cord DyskinesiaNot UnfittingVocal Cord Dysfunction -...

  • AF | PDBR | CY2011 | PD2011-00251

    Original file (PD2011-00251.docx) Auto-classification: Approved

    Chronic Neck Pain Condition . Other PEB Conditions . Service Treatment Record

  • AF | PDBR | CY2012 | PD2012 01381

    Original file (PD2012 01381.rtf) Auto-classification: Denied

    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. 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. xxPresident Physical Disability Board...

  • AF | PDBR | CY2011 | PD2011-00800

    Original file (PD2011-00800.docx) Auto-classification: Denied

    The PEB adjudicated the cervical spondylosis with neck pain and chronic mild left arm conditions as unfitting, rated at 20% for mild, incomplete paralysis. Magnetic Resonance Imaging (MRI) was performed in 2002 and although the radiologist’s report is not present in the record, both the original MEB NARSUM in May 2002 and the updated MEB NARSUM in December 2002 noted this test documented diffuse spondylitic changes from C3-4 to C6-7, severe spinal stenosis at C5-6, moderate spinal stenosis...

  • AF | PDBR | CY2014 | PD-2014-00909

    Original file (PD-2014-00909.rtf) Auto-classification: Denied

    The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of theVeterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation. The Board next considered if there was evidence of a functionally impairing radiculopathy due to the low back condition to provide additional rating. The Board considered the evidence in record supports thatthe CI’s...