RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXX	CASE:  PD-2014-01909
BRANCH OF SERVICE:  Air Force	BOARD DATE:  20140916
SEPARATION DATE:  20020102

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SRA/E-4 (39031/Security Police) medically separated for a left leg (S1 radiculopathy) condition.  The condition could not be adequately rehabilitated to meet the physical requirements of his Air Force Specialty or satisfy physical fitness standards and he was referred for a Medical Evaluation Board (MEB).  The left leg condition, characterized as “post-surgical S1 nerve root impingement causing radiculopathy with weakness in left leg and foot” by the MEB, was forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated “left S1 radiculopathy secondary to L5-S1 disk herniation status post left L5 hemilaminotomy and L5-S1 microdiskectomy” as unfitting, rated at 10% citing Department of Defense and Veterans Affairs Schedule for Rating Disabilities (VASRD) guidelines.  The CI made no appeals and was medically separated.

CI CONTENTION:  “Please review all conditions.”

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 left leg radiculopathy condition is addressed below; and, no additional conditions are 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.

RATING COMPARISON:

Service IPEB – Dated 20011002	VA - (~10 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left S1 Radiculopathy…	5293	10%	Post Surgical S1 Nerve Root Impingement w/Radiculopathy with Weakness of Left Leg and Foot	*5293-8520	20%	20021023	
			Post Surgical S1 Nerve Root Impingement with Painful and Limited Motion	*5293-5292	20%	20021023	
Other x 0 (Not in Scope)	Other x 2 	
Combined:  10%	Combined:  40%	
Derived from VA Rating Decision (VARD) dated 20021107 (most proximate to date of separation)
*Condition initially adjudicated VASRD code 5293 “Post-Surgical S1 Nerve Root Impingement w/Radiculopathy with Weakness of Left Leg and Foot” at 20% effective 20020103, then changed to above, 40% combined, effective 20020923.

ANALYSIS SUMMARY:  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 service 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.

Left S1 Radiculopathy Condition.  Service treatment records document that the CI, ruptured his (L5-S1) a lumbosacral disc in August 2000, while deployed to Kuwait.  His injury did not improve with conservative treatment; there was a loss of motor reflex and sensation in the left lower extremity.  A magnetic resonance imaging (MRI) study showed a large posterior left paracentral lumbosacral disc herniation.  He was referred to neurosurgery consultation and underwent surgery to decompress the nerve and disc removal (L5 hemilaminectomy and L5-S1 microdiscectomy) in January 2001.  An MRI dated 28 March 2001, suggested postoperative scarring and mild degenerative changes.  He continued to have back pain and developed weakness, numbness and shooting pain from the left buttock to the left leg and foot without any significant improvement.  He issued a L4 permanent profile and was referred for MEB.

The narrative summary dated 25 April 2001 (performed 8 months prior to separation), noted that the CI had left leg nerve pain (radiculopathy) that was constant and was worsened by physical activity such as bending, lifting and running.  He had decreased sensation and strength in the back of the left leg, outer left ankle and foot (the sacral nerve 1 distribution and innervation region).  He used Vicodin one to two tablets every 4 to 6 hours as needed for pain control and declined recommended additional surgical procedure.  The pain interfered with his ability to perform his duties as a security police officer.  During the physical examination, the examiner revealed that CI sat tilted to the right because pressure on left buttocks caused increased left leg pain.  There was mild pain over a healed scar in the center of the lower back, but no muscle spasm.  Straight leg raise test (for nerve involvement) on the left was grossly positive.  There was decreased sensation over the left lateral foot, 4/5 strength with dorsiflexion on the left and 1+ Achilles reflex on the left.  An MRI of lumbar spine dated 19 November 2001 demonstrated no focal nerve root impingement or spinal stenosis evident.  

At the VA Compensation and Pension (C&P) examination (performed 10 months after separation), the CI reported daily low back weakness with pain rated four on a scale of 1/10; he pain was as severe as before the surgery.  He reported flare-ups twice a week with pain level of 9/10, with duration of a half hour to an hour.  Prolonged standing, walking and sitting increased the pain which was relieved by stopping the activity.  He rarely used a cane.  The CI also reported a lack of endurance.  He felt his functional activities were 5% to 10% impaired because of his back pain had the greatest impact at the beginning and end of day.  The CI also reported the feeling of pins and needles in the left foot.  His walking was limited, he couldn’t exercise, couldn’t do ladder work but could perform limited home maintenance.  He reported his left knee had gone out on several occasions, as recently as the previous day.  He reported difficulty getting a job due to his back injury.  The VA C&P physical examination revealed no postural abnormalities and back muscles appeared normal.  The range-of-motion (ROM) showed flexion to 50 degrees, extension to 19 degrees; right lateral flexion to 14 degrees, left lateral flexion to 16 degrees and left and right rotation was 0 degrees on both sides.  Testing was conducted with consideration of pain, fatigue, weakness, lack of endurance, incoordination and was altered by repetition.  ROM was painful on both sides with flexion and extension.  The CI reported shooting pain from the left buttock to the bottom of the left leg and pain in the back of the left leg when bending toes or lifting the ball of his foot with the majority of pain in the calf area.  There was minimal atrophy of the left calf.  The Achilles and the patellar reflexes were absent in the left leg.  Left knee flexion was 60 percent with zero percent extension.  Testing was conducted with consideration of pain, fatigue, weakness, lack of endurance, incoordination, and was altered by repetition.  The examiner rendered a diagnosis of S1 nerve root impingement s/p laminectomy.
The Board directed attention to its rating recommendation based on the above evidence.  The PEB adjudicated the left S1 radiculopathy secondary to L5-S1 disk herniation status-post left L5 hemilaminectomy and L5-S1 micro-diskectomy condition as unfitting with a disability rating of 10% coded 5293 (intervertebral disc syndrome).  The VA rated the post-surgical S1 nerve root impingement with radiculopathy and weakness of the left leg and foot at 20%, coded 5293-8520 (intervertebral disc syndrome-incomplete paralysis of the sciatic nerve).  The VA also rated that painful limited motion coded 5293-5292, rated at 20%.  The Board considered whether criteria for a higher than the PEB 10% rating had been met under VASRD codes 5293 (intervertebral disc disease) or 8520 (incomplete paralysis of the sciatic nerve).  There was evidence of radiculopathy on multiple examinations by both the PEB and the VA.  The PEB noted a moderate loss of ROM of the lower back.  The CI had abnormal strength, sensation and an absent deep tendon reflex in his left lower extremity.  The commander’s statement indicated he had not been able to report for work since his original surgery date.  The Board determined that his radicular pain and neurological deficits rose to the moderate level consistent with a 20% disability under VASRD code 8520.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 20%, coded 5293-8520 for the left S1 radiculopathy 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 left S1 radiculopathy condition, the Board unanimously recommends a disability rating of 20%, coded 5293-8520 IAW VASRD §4.124.

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	
Left S1 radiculopathy Condition	5293-8520	20%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140501, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

		
XXXXXXXXXXXXXX
President
Physical Disability Board of Review

SAF/MRB

Dear XXXXXXXXXXXXXX:

	Reference your application submitted under the provisions of DoDI 6040.44 (Title 10 U.S.C. § 1554a), PDBR Case Number PD-2014-01909.

	After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was not appropriate under the guidelines of the Veterans Affairs Schedule for Rating Disabilities.  Accordingly, the Board recommended modification of your assigned disability rating without re-characterization of your separation with severance pay. 

	I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding, accept their recommendation and direct that your records be corrected as set forth in the attached copy of a Memorandum for the Chief of Staff, United States Air Force.  The office responsible for making the correction will inform you when your records have been changed.

							Sincerely,

XXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachments:
1.  Directive
2.  Record of Proceedings

cc:
SAF/MRBR
DFAS-IN