RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02076
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060713

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Military Police, medically separated for “chronic radiating low back pain” and “carpal tunnel syndrome of right (dominant) wrist,” each rated at 10%, with a combined disability rating of 20%.  

CI CONTENTION:  The CI contended her unfitting low back pain is worse and also indicated she suffers from right hand complications, high blood pressure, and anxiety disorder.  The complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The panel’s scope of review is defined in DoDI 6040.44.  It is limited to review of disability ratings assigned 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 or non-compensable.  Any conditions outside the panel’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 panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The panel’s assessment of the PEB rating determination 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(s) at the time of separation.  The panel 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 panel 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 - 20060505	VARD - 20061012	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Radiating LBP	5243	10%	Disc Herniation at L5-S1…	5243	20%	20060524	
CTS of Right (Dominant) Wrist	8799-8715	10%	Right CTS	8799-8715	10%	20060522	
Hypertension	Not Unfitting	Hypertension	7101	0%	20060524	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:  

Chronic Radiating Low Back Pain.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent surgery of her low back (microdiscectomy of left L5-S1 vertebral disc) in October 2005.  At the January 2006 MEB examination (recorded on DD Forms 2807 and 2808), 6 months prior to separation, the physical examination showed “severely restricted” range of motion (ROM) with tenderness of the mid and lower back.  At the 2 March 2006 MEB NARSUM examination, 4 months prior to separation, the CI reported constant low back pain (LBP) with “radiculopathy into the left buttock.”  Pain was rated at 6-7/10, but the CI indicated she was able to perform any type of physical activity without increase in symptoms.  Physical examination showed recorded a normal gait, but later in the report the examiner indicated the CI walked with a limp.  ROM was recorded as flexion to 70 degrees (normal 90) and combined ROM at 185 degrees (normal 240).  There was normal sensation, and strength, and no evidence of muscle atrophy, but reflex was absent to the left buttock.  Provocative testing for nerve root impingement was positive for the left lower extremity.  Spasm and pain were not addressed.  

The 24 May 2006 VA Compensation and Pension (C&P) evaluation, 2 months before separation, was not in evidence for review, although the 12 October 2006 VA rating decision did document findings from that visit.  The VARD indicated physical examination at the C&P recorded flexion at 50 degrees and combined ROM at 160 with evidence of painful motion throughout.  The VARD indicated the C&P recorded no evidence of additional loss of ROM due to pain.  

The panel directed attention to the rating recommendation based on the above evidence.  The PEB rated 10% for the LBP, coded 5243 (intervertebral disc syndrome), citing slight antalgic gait with no documentation of spasm, pain limited motion, paraspinal muscle tenderness, and no separately unfitting radiculopathy.  The VA rated the low back condition 20% coded 5243 (intervertebral disc syndrome) based on the C&P examination 2 months before separation, citing forward flexion of 50 degrees.  The panel noted the disparity between the NARSUM and C&P examinations and carefully reviewed evidence proximate to separation to determine the probative value of each examination.  The MEB examination supported a 10% rating based on limitation of thoracolumbar ROM while the VA rating decision recorded C&P findings that were more proximate to separation and supported a 20% rating based on ROM.  The ROMs recorded during the 2 examinations were not so different as to be inconsistent with the CI’s back condition.  Panel members agreed that both the NARSUM and VA examinations were of equal quality with regard to rating the back condition at the time of separation and also noted that there was no other evidence proximate to separation which would add weight favoring the 20% versus the 10% rating.  The panel majority placed more probative value on the direct transcription of the NARSUM vice the second-hand transcription of the C&P examination (via the VARD).  There was no additional documentation of more significant ROM limitations (flexion greater than 30 degrees but not greater than 60 degrees) or ankylosis to support a higher rating.  There was no evidence of intervertebral disc syndrome or incapacitating episodes requiring physician prescribed bed rest for a higher rating under that formula.  Therefore, after due deliberation, considering the totality of the evidence and in consideration of reasonable doubt (§4.3), the panel majority concluded there was insufficient evidence to favor the 20% rating over the 10% rating, and therefore cannot recommend a change in the PEB adjudication for the LBP.  

Carpal Tunnel Syndrome, Right Wrist.  According to the STR and the MEB NARSUM, the carpal tunnel syndrome (CTS) of the right (dominant) wrist began in the spring of 2005.  Electrophysiologic studies in May 2005 documented evidence of a right median sensory neuropathy consistent with CTS.  At the 2 February 2006 MEB orthopedic NARSUM addendum examination, 5 months prior to separation, the CI reported hand pain with only partial relief after wearing splints.  The physical examination showed “typical” carpal tunnel findings of median nerve (one of the five main nerves of the hand) irritability (positive Phalen and Tinel testing) with decreased sensitivity.  Surgical intervention was declined by the CI.  The 12 October 2006 VA rating decision documented examination findings from that visit.  The CI reported wear of a night splint, constant pain, continuous tingling, numbness, swelling, and cramping, worsened by repetitive motion.  

The panel directed attention to the rating recommendation based on the above evidence.  The PEB rated 10% for the CTS, analogously coded 8799-8715 (median nerve, paralysis of, incomplete, mild), citing clinical findings of CTS without muscle atrophy.  The VA also rated 10% for the CTS via the same code (8799-8715) based on the C&P examination 2 months before separation, citing mild, incomplete paralysis of hand movements.  There was no evidence of decreased strength or atrophy, decreased ability to make a fist, or ROM deficits of the wrist to support a moderate disability rating of 30% IAW VASRD §4.124a.  After due deliberation in consideration of the preponderance of the evidence, the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the right CTS condition.  

Contended PEB Conditions:  Hypertension.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The contended condition was not profiled, implicated in the commander’s statement, or judged to fail retention standards.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the LBP condition and IAW VASRD §4.71a, the panel majority recommends no change in the PEB adjudication.  The single voter for dissent recommended modification of the disability rating and did not elect to submit a minority opinion.  In the matter of the right CTS condition and IAW VASRD §4.124a, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the contended hypertension condition, the panel unanimously recommends no change from the PEB determination as not unfitting.  There were no other conditions within the panel’s scope of review for consideration.  The panel, therefore, recommends there be no modification or re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150719, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170011078, XXXXXXXXXXXXXXXXXX

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Dear XXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction.

Sincerely,