RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00512
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20091222

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Food Service Specialist, medically separated for “degenerative arthritis, lumbar spine” and “left lower extremity radiculopathy,” rated 10% and 10%, respectively, with a combined disability rating of 20%.

CI CONTENTION:  The CI contends that his back condition with nerve damage continues to worsen and negatively impacts his daily activities.  His complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited to those conditions determined by the Physical Evaluation Board (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 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 based on 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.  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 PEB – 20090831	VARD – 20130427	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Degenerative Arthritis, Lumbar Spine	5242	10%	Low Back Pain, L4/5 and L5/S1 Disc Disease	5237	NSC	STR	
Left Lower Extremity (LLE) Radiculopathy	8799-8720	10%	LLE Radiculopathy	8599-8520	NSC	STR	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Degenerative Arthritis, Lumbar Spine.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s back condition began approximately 2 years prior to referral for an MEB.  A 2 June 2008 lumbar spine diagnostic imaging (MRI) study was essentially unremarkable with no neurocompressive disease.  There was a small disc bulge at L4-5 with no evidence of annular (disc fibrous exterior) tear or herniation.  A 26 September 2008 lumbar spine MRI showed mild degenerative disc disease (DDD), mild bulging annuli at L4-L5 and L5-S1 resulting in mild L4-L5 canal stenosis (narrowing), and mild left neural foraminal (nerve root opening) stenosis.  Evaluation by orthopedics concluded with a diagnosis of bulging disc (L4-L5) with no surgical indication.  At the 27 May 2009 orthopedic examination, the examiner found the CI to have decreased range of motion (ROM) in all planes of motion.  There was no report of pain with motion and measurements were not listed in the examination findings.  The CI had normal strength, reflexes, and sensation and examination tests for radiculopathy (nerve root irritation or injury) were negative.  Despite treatment with physical therapy and nerve root injections, the back condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty he was referred for an MEB.  The MEB forwarded “chronic low back pain” for PEB adjudication.  During the 30 July 2009 MEB examination (MEB NARSUM and DD Forms 2807 and 2808), 5 months prior to separation, the CI reported sharp pain that started in the center of the low back and radiated up the back on the left side.  He reported numbness in the left leg that radiated into the heel.  His back pain was exacerbated by prolonged sitting, standing, or walking.  He had flare-ups once a day that lasted 2-3 hours.  Physical examination showed ROM of 65 (90 normal) degrees after repetition and combined ROM of 170 (240) degrees after repetition.  Pain was elicited in every plane of motion and was the cause of his limitation.  He ambulated with an antalgic gait (a gait or posture to lessen pain), but the examination was silent regarding the presence of spasm or guarding.  His spinal contour was normal.  He had normal strength and sensation, but his sensory examination revealed numbness in the left leg that was not restricted to any dermatomal distribution.  Examination tests for sciatica (radiating pain along sciatic nerve distribution) were negative.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, coded 5242 (degenerative arthritis of the spine), citing limitation of motion.  The Board agreed that a 10% rating, but no higher, was justified for limitation of flexion greater than 60 degrees but not greater than 85 degrees reported on the MEB examination proximate to separation.  There was no muscle spasm or guarding severe enough to result in an abnormal gait or spinal contour, thus the next higher 20% rating was not justified on this basis.  After due deliberation, and 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 back condition.  

LLE Radiculopathy Condition.  According to STRs and the MEB NARSUM, the symptoms of pain radiating into the LLE began approximately 2 years prior to referral for an MEB.  At a 27 August 2008 pain management encounter, the CI complained of lumbosacral low back pain (LBP) with left hip and posterior thigh radiation, and some numbness since November 2007.  Symptoms of numbness were exacerbated following a motor vehicle accident to include the left leg and the entire foot in the L5-S1 distribution.  He reported occasional left leg weakness, but denied bowel or bladder dysfunction.  The physical examination documented an intact gait (heel-toe walk).  The back examination revealed tight paraspinal musculature and tenderness over the L-4, L-5, and S-1 facets.  The left straight leg raise (SLR) test (assesses for herniated disc causing sciatic nerve root [L5-S1] radiculopathy) and piriformis test (assesses for piriformis muscle compressing sciatic nerve) were positive.  The LLE examination revealed mildly decreased strength compared to the right.  Left L-5 pinprick sensation was decreased.  The deep tendon reflexes (DTRs) were normal.  The assessment listed lumbar radiculopathy.  A 26 September 2008 lumbar spine MRI showed DDD, bulging L4-L5/L5-S1 annuli, and L4-L5 canal and left neural foraminal stenosis, all characterized as mild.  The 30 July 2009 report of medical history, examination, and assessment for the MEB documented decreased sensation in the left leg to pinprick and light touch in a non-dermatomal (area of skin sensation from a single nerve root) pattern.  In the NARSUM the CI complained of LBP with associated numbness in the left leg that radiated into the heel.  The physical examination documented an antalgic gait with no assistive devices.  The SLR tests were negative.  Strength, DTRs, and sensation were normal except for “numbness on the left leg not restricted to any dermatomal distribution.”  The examiner recounted the findings of the MRIs.  The diagnosis listed left leg numbness which met retention criteria.  At a 21 August 2009 physical medicine evaluation, the CI complained of LBP radiating to the LLE with numbness of all toes.  A focused physical examination revealed strength, DTRs, and sensation were normal except for decreased pinprick sensation of the right great toe.  Electrodiagnostic studies (electromyogram/nerve conduction velocity) findings were compatible with a left L-5 radiculopathy.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under an analogous 8720 code (neuralgia, sciatic nerve) citing LLE radiculopathy, pain goes down left leg into heel, no neurological deficits, and rated as mild incomplete paralysis.  The 27 April 2012 VA rating decision, 4 years after separation, did not service connect the LLE radiculopathy.  Recognizing the remote temporal relationship to the date of separation, the Board assigned little probative value to the VARD.  Peripheral neuralgia are usually characterized by dull and intermittent pain, of typical distribution so as to identify the nerve.  The neuralgia codes are rated based on an assessment of functional impairment expressed in terms of severity of paralysis.  The neuralgia code (8720) is limited to a maximum of moderate incomplete paralysis (§4.124) which is a 20% rating.  Members agreed that findings were concordant with mild incomplete paralysis, consistent with a 10% rating under 8720 (sciatic nerve, paralysis of).  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 LLE radiculopathy condition.  

BOARD FINDINGS:  In the matter of the back condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the radiculopathy 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.  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 20150601, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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 
XXXXXXXXXXXXXXXXXX, AR20160018736 (PD201500512)

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:

Enclosure

CF: 
(  ) DoD PDBR
(  ) DVA