Upgrade.Vet

AF | PDBR | CY2013 | PD-2013-02650

Original file (PD-2013-02650.rtf) Auto-classification: Denied

RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXX CASE: PD-2013-02650
BRANCH OF SERVICE: Army BOARD DATE: 20150811

SEPARATION DATE: 20040427

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Attack Helicopter Repairer) medically separated a cervical spine condition which could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS) or satisfy physical fitness standards. He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB). The condition “neck, shoulder, and arm pain secondary to degenerative disc disease” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. The MEB also identified and forwarded two other conditions (carpal tunnel syndrome and hearing loss) for PEB adjudication, which were judged to meet retention standards. The Informal PEB adjudicated the cervical condition as unfitting, rated 10%, citing criteria of the Veterans Affairs Schedule for Rating Disabilities (VASRD). The remaining conditions were determined to be not unfitting . The CI made no appeals, and was medically separated.

CI CONTENTION: “My ability to perform day to day activities is more difficult due to my worsening condition.”

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 when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting. Any conditions outside the Board’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/Naval Records. Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate. The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the VASRD standards to the unfitting medical condition at the time of separation. The Board 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, operating under a different set of laws. The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.

RATING COMPARISON :

Service IPEB – Dated 20040105	VA* - (5+ Months Pre-Separation)
Condition	Code	Rating	Condition	Code	Rating	Exam
Neck, Shoulder, and Arm Pain…	5237	10%	Degenerative Disc ... Cervical Spine	5242	20%	20031112
Other x 2 (Not In Scope)	Other x 3
Combined: 10%	Combined: 40%

* Derived from VA Rating Decision (VA RD ) dated 200 40227 (most proximate to date of separation [ DOS ] ).

ANALYSIS SUMMARY :

Cervical Spine. The service treatment record (STR) corroborated the history in the narrative summary (NARSUM) of an onset of neck pain with bilateral radicular symptoms following a whiplash injury from a vehicular accident in March 2002 (2+ years prior to separation). The symptoms persisted in spite of conservative measures, and earlier entries noted decreased range-of-motion (ROM), sensory and motor complaints, and inconsistent neurologic deficits. Imaging demonstrated degenerative changes and bi-level disc disease (C3/4, C5/6) with some right-sided nerve root impingement. Neurosurgical and physical medicine consultants found no neurologic abnormalities, and surgery was not recommended. The symptoms did not adequately improve with a protracted trial of further conservative interventions (physical therapy [PT], chiropractic, acupuncture, epidural steroid injection) and a MEB was initiated. A neurology consultant 2 weeks prior to the NARSUM noted reflex and sensory findings (no comment motor strength) consistent with bilateral carpal tunnel syndrome (CTS), predominantly on the right, which was confirmed by electrodiagnostic testing; and, opined that this was distinct from cervical nerve injury. The same consultant noted very restricted ROM in the right lateral and rotational planes, without attendant muscle spasm, which was characterized as “rarely found ... rather unusual.” These findings and opinions were stressed in the NARSUM. There is no consistent evidence for grossly abnormal ROM observations in the STR, no consistent evidence for abnormal neurological findings or objective strength deficits, no documentation of abnormal spinal contour, and no documentation of periods of incapacitation.

The NARSUM was conducted 12 September 2003 (7 months prior to separation), and documented continued neck pain and “intermittent numbness and tingling on the left more than the right upper extremity” with “no gross improvement in the symptomatology;” specifying only profile limitations. The NARSUM physical examination recorded “loss of the normal lordotic curve” but “no paravertebral muscle spasm;” and, the neurological and ROM findings appeared to have been taken from the neurology consult detailed above. There are two sets of complete goniometric ROM measurements performed for the MEB by PT, and these are charted below.

A VA Compensation and Pension (C&P) examination was conducted 12 November 2003 (6 months prior to separation), and documented that the CI “complains of neck pain, decreased mobility of his neck, and occasional numbness predominantly his left but also his right hand, prohibiting him from continuing to function in his current military job.” The VA physical examination recorded a normal spinal contour without comment regarding spasm or tenderness, and normal neurological findings (5/5 strength). Bilateral grip strength measurements (right hand dominant) were in the normal range. The VA measured ROM is charted below, and recorded marked bilateral limitations of lateral and rotational motion.

The ROM evaluations referenced above, which the Board weighed in arriving at its rating recommendation, are summarized in the chart below.

Cervical ROM	MEB PT ~7 Mo. Pre-Sep	VA C&P ~6 Mo. Pre-Sep	MEB PT ~5 Mo. Pre-Sep
Flexion (45⁰ Normal)	35⁰	45⁰	35⁰
Combined (340⁰)*	215⁰	140⁰*	285⁰
§4.71a Rating	10%	20%	10%

* §4.71a 20% criterion is ≤ 170⁰.

The Board directed attention to its rating recommendation based on the above evidence. The PEB’s 10% rating under code 5237 (cervical strain) was consistent with VASRD §4.71a criteria for the service ROM evidence. The VA’s 20% rating under 5242 (degenerative arthritis of the spine) was premised on the combined ROM criterion footnoted in the chart above. The Board deliberated whether the probative value of the combined ROM evidence from the C&P weighed sufficiently in support of a 20% recommendation; but, members agreed that the conflicting evidence from the PT measurements both before and after the VA measurements detracted significantly from the probative value of the VA evidence; and, that the neurologist’s opinion with regard to the nature of the lateral/rotational limitations was also a probative value detractor. Additionally it was considered whether abnormal spinal contour (a §4.71a 20% criterion), as documented in the NARSUM, would justify a 20% recommendation; but, members agreed that the requisite “muscle spasm or guarding severe enough to result in ... abnormal spinal contour” (§4.71a qualifier) was not sufficiently demonstrated by the evidence to support the criterion.

Finally, the Board considered whether additional rating could be recommended under a peripheral nerve code for the associated radiculopathies in evidence at separation. Firm Board precedence requires a functional impairment linked to fitness to support a recommendation for addition of a peripheral nerve rating to Service disability in spine cases. The pain component of a radiculopathy is subsumed under the general spine rating as specified in §4.71a. The Board considered if the intermittently documented motor (strength) impairment and more convincingly documented hand sensory impairment were a sufficient basis for supporting additional nerve rating in this case, especially considering that they were more prominent on the dominant right side in an MOS requiring dexterity. It was considered, however, that the predominance of evidence (including measured grip strength) did not corroborate the presence of functionally significant motor or sensory deficits as a consistent finding. Furthermore it is clear from the neurology evidence that CTS played a significant role in whatever functional impairment may have existed; and, that condition is neither within the Board’s scope of review nor could it be convincingly demonstrated as separately unfitting if it were. It is also noted that the VA did not find justification for a ratable neuropathy in this case independently of the fitness question. Members agreed, therefore, that additional rating for unfitting peripheral nerve impairment was not adequately supported. 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 of the cervical spine 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 cervical spine 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.

The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20131209, w/atchs
Exhibit B. Service Treatment Record

Exhibit C. Department of Veterans Affairs Treatment Record

XXXXXXXXXXXXXXX
President
DoD 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 XXXXXXXXXXXXXXX, AR20150013359 (PD201302650)

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              XXXXXXXXXXXXXXX
                           Deputy Assistant Secretary of the Army
                           (Review Boards)

CF:
( ) DoD PDBR
( ) DVA

Similar Decisions

AF | PDBR | CY2013 | PD-2013-02273

Original file (PD-2013-02273.rtf) Auto-classification: Approved

RATING COMPARISON : Service IPEB – Dated 20041027VA - Based on Service Treatment Records (STR)ConditionCodeRatingConditionCodeRatingExam Chronic Neck and Shoulder Pain with Right Arm Numbness5237 -871610%Cervical Disc Herniation at C5-C6 with RUE Radiculopathy5342-871610%STROther x 0 (Not in Scope)Other x 3 STR Combined: 10%Combined: 10%Derived from VA Rating Decision (VARD)dated 20050506 ( most proximate to date of separation [DOS]). In the matter of the Service-combined cervical spine and...
AF | PDBR | CY2014 | PD-2014-02578

Original file (PD-2014-02578.rtf) Auto-classification: Approved

The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation. Although the narrative summary (NARSUM) dates the onset of both the cervical and lumbar complaints to a fall in July 2006, the service treatment record (STR) contains an entry from May 2006 with a complaint of “mild...
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...
AF | PDBR | CY2013 | PD-2013-02571

Original file (PD-2013-02571.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 the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation. At a pain managementevaluation on 11 March 2005 the CI reported no upper extremity symptoms and there was reduced cervical ROM with normal strength and TTP of the cervical spine (facet pain), with positive evidence of...
AF | PDBR | CY2014 | PD-2014-01050

Original file (PD-2014-01050.rtf) Auto-classification: Approved

SEPARATION DATE: 20090626 The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation. 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...
AF | PDBR | CY2012 | PD2012 01732

Original file (PD2012 01732.rtf) Auto-classification: Denied

Upon InformalReconsideration following the appeal, the PEB adjudicated the cervical spine (subsuming myofascial pain) and lumbar spine conditions as unfitting, rated 10% each, citing criteria of the Veterans Affairs Schedule for Rating Disabilities (VASRD). Since the PEBadjudicated polyneuropathy and iliotibial band syndrome were integral to the VA “findings” cited in the application, members agreed that those conditions were appropriately included in the Board's scope of review; and, are...
AF | PDBR | CY2011 | PD2011-00801

Original file (PD2011-00801.docx) Auto-classification: Denied

PHYSICAL DISABILITY BOARD OF REVIEW SCOPE OF REVIEW : The Board wishes to clarify that the scope of its review as defined in DoDI 6040.44 is limited to those conditions which were determined by the PEB to be specifically unfitting for continued military service; or, when requested by the CI, those condition(s) “identified but not determined to be unfitting by the PEB.” Since none of the conditions determined to be unfitting by the PEB are requested for review, only the rated cervical spine...
AF | PDBR | CY2013 | PD-2013-02152

Original file (PD-2013-02152.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 the VASRD standards to the unfitting medical condition at the time of separation. There is an addendum to the NARSUM dated 13 July 2004 (7 months prior to separation) which documents constant pain rated 3-10/10 with radicular symptoms “left greater than right” and “exacerbated by prolonged sitting and standing.” The exam documents a normal gait and...
AF | PDBR | CY2014 | PD2014 00906

Original file (PD2014 00906.rtf) Auto-classification: Approved

The VARD also noted the absence of radicular findings and no recording of ROM (the CI refused testing).The Board directs attention to its rating recommendation based on the above evidence.The PEB rated the condition for ROM limited by pain, coded 5237, and assigned a rating of 0%.The VA rated the condition under code 5242, 10% for muscle spasm.Under the applicable spine rules, a rating of 10% requires cervical spine flexion of greater than 30 degrees but less than 40 degrees or a combined...
AF | PDBR | CY2013 | PD-2013-02358

Original file (PD-2013-02358.rtf) Auto-classification: Approved

Post-Separation) ConditionCodeRatingConditionCodeRatingExam Myofascial Pain Syndrome(Cervical and Left Trapezius)502120%Cervical Strain with Headaches523720%20050503Left Shoulder AC Separation52010%20050503No Other Item in ScopeOther x 4 (Not in Scope)20050503 Combined: 20%Combined: 40%Derived from VA Rating Decision (VARD)dated 20050615(most proximate to date of separation). Of note, the MEB PT cervical ROM evaluation noted that cervical flexion was associated with “pain into left upper...

Search Decisions

Decision Text

AF | PDBR | CY2013 | PD-2013-02650

Similar Decisions