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AF | PDBR | CY2013 | PD-2013-02715
Original file (PD-2013-02715.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXX    CASE: PD-2013-02715
BRANCH OF SERVICE: Army  BOARD DATE: 20150120
SEPARATION DATE: 20070816


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was a National Guard E-7 (Maintenance Supervisor) medically separated for chronic neck pain due to degenerative disc disease (DDD). The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards. He was issued a permanent U3 profile and referred for a Medical Evaluation Board (MEB). The neck condition, characterized as two unfitting conditions, “chronic neck pain due to degenerative disc disease and degenerative facet disease” and “chronic cervical neuritis with radicular symptoms left upper extremity (LUE) with negative electrodiagnostic study,” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. No other conditions were submitted by the MEB. The Informal PEB adjudicated “chronic neck pain due to degenerative disc disease without neurosensory deficit” as unfitting, rated 10%, with likely application VA Schedule for Rating Disabilities (VASRD). The remaining radicular condition w as determined to be not separately unfitting by the I nformal PEB as “there is no neurologic deficit.” 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 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 20070705
 VA - (10 Mos. Pre -Separation)
Condition
 Code Rating Condition Code Rating Exam
Chronic Neck Pain due to Degenerative Disc Disease 5299-5237 10% Cervical Spine Degenerative Disc Disease w/ Lt Arm Radiculopathy 5242 10% 20061106
Chronic Cervical Neuritis LUE … Not Unfitting
Other x 0 (In Scope)
 Other x 4
Combined: 10%
 Combined: 30%
Derived from VA Rating Decision (VA RD ) dated 200 61226 ( most proximate to date of separation [ DOS ] ).


ANALYSIS SUMMARY:

Neck Condition and Chronic Cervical Neuritis with Radicular Symptoms Left Upper Extremity. The narrative summary (NARSUM), as supported by the service treatment record, detailed that the CI suffered neck pain that radiated down his left arm beginning in 2005. He also complained occasional numbness, tingling, and weakness in the left arm and hand. He was treated conservatively with epidural steroid injections, physical therapy, anti-inflammatory medication and narcotic pain medication and did not improve. Imaging (X-ray and magnetic resonance imaging) showed congenital fusion of C2-3 with degenerative changes, DDD, bulging discs, left C5-6 disc osteophyte with encroachment and mild stenosis. Electrophysiological studies (EMG/NCV) were negative for LUE radiculopathy and neuropathy and the CI was not a surgical candidate. At the time of the NARSUM, 3 months prior to separation, the CI complained of constant neck pain 3/10 intensity and “pain radiating down the left arm as far as the fingers” once or twice a week. Exam documented cervical tenderness, muscle spasm and painful motion with goniometric range-of-motion (ROM) documenting forward flexion to 40 degrees (normal 45 degrees) and combined 195 degrees (normal 340 degrees) with no additional limitation on repetition. Reflex, motor and sensory testing was all normal.
At the VA Compensation and Pension exams performed 10 months prior to separation, the CI reported neck pain with radiculopathy to the left arm with weekly flare ups. He also had episodic left arm pain and tingling. Exam documented painful ROM with forward flexion to 45 degrees (normal) and combined 270 degrees (normal 340 degrees). There was no additional limited ROM on repetition. There was no muscle spasm, atrophy, guarding, tenderness, weakness, or ankylosis. And neck contour was normal. Neurological testing showed no motor, sensory, or reflex deficit. Neurologic evaluation included a diagnosis of bilateral carpal tunnel syndrome with EMG/NCV indicated mild bilateral carpel tunnel syndrome, mild with “No electrical evidence of cervical radiculopathy, however a sensory radiculopathy can be present with normal EMG.” Detailed sensory exam for vibration, pain, light touch and position sense were normal in the LUE. VA records indicate the CI’s left wrist and cervical radiculopathy were rated as a single 20% condition effective in November 2012.

The Board directed attention to its rating recommendation based on the above evidence. With regards to the neck condition, the PEB rated the neck condition at 10% under code 5299-5237 pain limited motion and tenderness. The VA rated the condition at 10% under code 5242, citing painful limited combined ROM. All ROMs in evidence supported no higher than a 10% rating (forward flexion greater than 30 degrees but not greater than 40 degrees; or, combined ROM greater than 170 degrees degrees but not greater than 335 degrees). The Board did not see any pathway to a higher rating under ankylosis of the spine, muscle spasm or guarding severe enough to result in an abnormal spinal contour, or physician-prescribed bed-rest with duration of at least 2 weeks during the past 12 months. 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 neck condition.

With regards to the chronic cervical neuritis with radicular symptoms LUE, the PEB considered it not unfitting and the VA included it in their cervical rating until symptoms increase in 2012, where they considered the left radiculopathy with an increased left carpal tunnel rating. The Board considered if the CI’s chronic cervical neuritis with radicular LUE symptoms (occasional numbness and tingling) was unfitting and warranted an additional disability rating. The pain component of a radiculopathy is subsumed under the general spine rating as specified in §4.71a. and was considered in the neck rating above. There was no objective evidence of motor, sensory, or reflex deficiency proximate to separation. As noted above, EMG/NCV testing was also negative for cervical radiculopathy. The remote left arm worsening in 2012 was not considered indicative of the CI’s disability picture at separation. Members agreed that the requisite link of left arm symptoms with functional impairment and duty limitations was not in evidence. 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 the chronic cervical neuritis LUE 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 and IAW VASRD §4.71a., the Board unanimously recommends no change in the PEB adjudication. In the matter of the cervical neuritis (LUE) condition, 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, 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 20131218, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans Affairs Treatment Record







XXXXXXXXXXXXXX
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, AR20150010432 (PD201302715)


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

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