RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00694
BRANCH OF SERVICE:  NAVY	SEPARATION DATE:  20040629

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Field Medical Service Technician, medically separated for “left L5/S1 radiculopathy” with a disability rating of 10%.  

CI CONTENTION:  “Review of all conditions.”  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 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 - 20040313	VARD - 20050616	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left L5/S1 Radiculopathy	5243	10%	Lumbar Strain - Myositis…	5237	20%	20050507	
			Clinical L5 Radiculopathy associated with Lumbar Strain - Myositis…	8520	10%	20050507	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Left L5/S1 Radiculopathy.  According to the service treatment record and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI first sought medical attention for his low back pain (LBP) in late 2002, reporting a 2-year history of LBP with radiation to the left calf.  MRI showed a small L4-5 disc herniation.  During the 29 October 2003 neurosurgery appointment, 8 months before separation, the CI reported increased LBP which radiated to the left leg and foot.  This radicular pain increased when the CI bent forward.  Physical examination revealed spinal tenderness and muscle spasms with range of motion (ROM) of flexion to 70 degrees (normal 90), extension to 10 degrees (normal 30), and lateral flexion to 15 degrees bilaterally (normal 30); combined ROM was incomplete and painful motion was not addressed.  Straight leg raising (SLR) test for radiculopathy was positive on the left.  Motor function, sensory function, and reflexes were normal.  The CI had a second lumbar spine MRI 3 days later showed an L4-5 herniated disc causing moderate stenosis (spinal canal narrowing), a mild L5 displacement of the descending nerve root, and a smaller L3-4 herniated disc causing mild to moderate stenosis.  The CI had a follow-up neurosurgery appointment on 5 November 2003 where an L4-5 laminectomy/discectomy surgery was recommended.  ROM was the same as at the aforementioned appointment.  There was spinal tenderness but no muscle spasm.  The CI declined surgery and epidural steroidal injections to treat his LBP, and he was referred to the MEB.  

The 19 December 2003 MEB NARSUM examination, 6 months prior to separation, noted complaints of LBP that radiated to the left leg when he bent down; also episodic numbness and tingling to the left leg, foot and toes.  The CI was unable to sit upright, leaning to his right to alleviate his pain.  Physical examination referenced the aforementioned 29 October 2003 and 5 November 2003 neurosurgery examination ROMs.  Spinal tenderness, muscle spasm, gait, and contour were not addressed.  SLR testing for radiculopathy was positive.  S1 and L4 dermatomes (sensation distribution from S1 and L4 nerve roots) had decreased sensation to pinprick of the left leg but bilateral motor strength was full.

At primary care appointment on 24 February 2004, 4 months before separation, the CI reported no improvement with a course of Naprosyn (anti-inflammatory) but did improve with reduced impact-type exercises.  The CI continued to have daily mildly to moderately left lower extremity radicular pain symptoms.  The examiner reported reduced flexion secondary to pain with good-lateral flexion and extension, but did not provide measurements.  The neurologic examination (motor strength and sensation) was normal.

At the 30 November 2004 VA Compensation and Pension (C&P) General evaluation, 5 months after separation, the CI reported LBP and left big toe pain.  Physical examination showed a normal gait and posture; muscle spasm and tenderness.  There was no swelling, effusion or ankylosis.  ROM was “normal” flexion and extension without providing measurements.  Reflexes, coordination and sensation were normal.

At the 7 May 2005 C&P spine evaluation, 10 months after separation, the CI reported LBP that radiated down his left leg, foot and toes.  He reported weekly flare-ups but denied any hospitalization due to intervertebral disc syndrome (IVDS) in the past year.  Physical examination showed spinal tenderness and spasm with a normal gait and contour.  Thoracolumbar ROM showed flexion to 60 degrees and combined ROM was 180 (normal 240); painful motion was reported.  Repetitive ROM was not addressed.  There was a decreased pinprick sensation in the left lower extremity, specifically at the L5/S1 dermatome in the left foot, and normal motor strength and reflexes.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the LBP condition 10%, coded 5243 (IVDS).  The VA rated the LBP condition 20%, coded 5237, (lumbosacral strain), based on the C&P spine examination 10 months after separation, citing evidence of pain upon repetitive flexion of the thoracolumbar spine.  The VA additionally rated the L5 radiculopathy condition 10%, coded 8520 (sciatic nerve, paralysis of, incomplete: mild) based on the same C&P examination, citing an abnormal sensory examination.  

The panel agreed that a 10% rating, but no higher, was justified for limitation of flexion (greater than 60 degrees but not greater than 85 degrees); as reported on the neurosurgery and MEB NARSUM examinations, proximate to separation; which was corroborated by the General C&P examination 5 months later.  Although there was muscle spasm, it was not severe enough to result in an abnormal gait or spinal contour, thus the next higher 20% rating was not justified on this basis.  There was no evidence of IVDS which resulted in incapacitating episodes requiring physician-prescribed bed rest to warrant consideration of rating under the alternate VASRD formula for that condition.  The limitation of thoracolumbar motion at the NARSUM examination supported the 10% rating adjudicated by the PEB. 

The panel also considered if additional disability rating was justified for peripheral nerve impairment due to radiculopathy.  The presence of functional impairment with a direct impact on fitness is the key determinant in the panel’s decision to recommend any condition for rating as additionally unfitting.  While the CI may have suffered additional pain from the nerve involvement, this is subsumed under the general spine rating criteria, which specifically states “with or without symptoms such as pain (whether or not it radiates).”  Therefore the critical decision is whether or not there was a significant motor weakness which would impact military occupation-specific activities.  There was no evidence in this case that motor weakness existed to any degree that could be described as functionally impairing.  The panel therefore concluded that an additional disability rating was not justified on this basis.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the LBP condition.

BOARD FINDINGS:  In the matter of the LBP condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  There are no other conditions within the panel’s scope of review for consideration.  Therefore, the panel recommends 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 20160912, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW
               BOARDS 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS
 
Ref:   (a) DoDI 6040.44

      In accordance with reference (a), I have reviewed the cases listed below and approve the recommendations of the PDBR that the following individual’s records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy’s Physical Evaluation Board:

		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN