RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01309
BRANCH OF SERVICE:  ARMY	SEPARATION DATE:  20040916

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Light Wheeled Vehicle Mechanic, medically separated for “low back pain” and “peripheral neuropathy of right femoral nerve” rated 10% each, with a combined disability rating of 20%.

CI CONTENTION:  He was not evaluated for his right hand, right testicle and tinnitus 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(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 - 20040803	VARD - 20050310	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Low Back Pain	5243	10%	Hernia Ted and Degenerative Disc Disease (DDD), Lumbar Spine	5243	20%	20050111	
Peripheral Neuropathy of Right Femoral Nerve	5243-8726	10%					
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Low Back Pain (LBP).  According to the service treatment record (STR) and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s LBP condition began in June 2003 without specific injury or trauma.  MRI dated 14 August 2003 showed an L5-S1 bulging disk with a small right herniation and mild right L5-S1 level encroachment and L5-S1 region disk degeneration.  Treatment on 29 September 2003 consisted of Celebrex (celecoxib, a nonsteroidal anti-inflammatory drug) and MS Contin (morphine, a narcotic).  Physical therapy was instituted on 18 November 2003 after the CI had no relief from medication and epidural steroid injections.  
A neurosurgical evaluation on 29 March 2004 indicated the CI had an L5-S1 bulging disc and DDD with a probable right leg peripheral-type neuropathy.  Electrodiagnostic testing revealed chronic right L4-L5 nerve roots radiculopathy affecting the underlying mixed axonal demyelinating sensory and motor neuropathy.  A CT scan on 8 April 2004 showed L4-L5 and L5-S1 DDD with mild left posterior L4-L5 and L5-S1 disk bulging.  There was also questionable right nerve root clumping, which may have been related to arachnoiditis (inflammation).  The neurosurgeon noted on 19 April 2004 the source of pain was the L5 and S1 nerve roots that came off the same trunk and was right over the bulging disc which then pushed the nerve up into the joint.  The physician’s recommendation was to do nothing at that time; however, should the pain become severe, a right L5-S1 facet block and/or an anterior lumbar diskectomy and fusion were recommended, with the possibility of a future anterior joint disk replacement. 

During the 24 May 2004 MEB examination (recorded on DD Forms 2807-1 and 2808), 4 months prior to separation, the CI reported his “back [was] all jacked up” and his legs went numb and tingled.  Physical examination showed pain with flexion and spinal tenderness.  The 12 July 2004 MEB NARSUM examination, 2 months prior to separation, noted complaints of midline lumbar region pain, which was sharp between 6-8/10 and worsened with movement, bending over, and heavy lifting; but improved with rest and medications.  Physical examination revealed repetitive range of motion (ROM) with flexion to 80, 82, and 80 degrees (normal 90), extension 30 degrees, right and left rotation 30 degrees each, and right and left lateral bending 30 degrees each; combined ROM was 230 degrees (normal 240).  There was a normal heel-toe walk and straight leg raise (SLR) testing (to determine nerve root irritation) was negative.  

At the 11 January 2005 VA Compensation and Pension (C&P) evaluation, 4 months after separation, the CI reported continuous back pain and intermittent bilateral foot tingling.  There were no focal neurological deficits.  Lumbar examination revealed flexion to 45 degrees with fingertip to ground measuring 21 inches, extension was 30 degrees, bilateral lateral rotation was 30 degrees; bilateral lateral flexion was 30 degrees; combined ROM was 195 degrees.  The CI had pain or discomfort with all phases of mobility of the lumbar spine.  SLR was positive.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the LBP condition 10%, coded 5243 (intervertebral disc syndrome (IVDS)), citing forward flexion of 82 degrees.  The VA rated the LBP condition 20%, also coded 5243, based on the C&P examination 4 months after separation, citing forward flexion to 45 degrees.  

The panel agreed a 10% rating, but no higher, was justified for limitation of flexion (greater than 60 degrees but not greater than 85 degrees), or combined ROM greater than 120 degrees but not greater than 235 degrees, as reported on the MEB NARSUM 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.  

At the post‐separation C&P examination the CI reported no interim history of further injury, surgery, or other aggravation of the condition.  While ROM limitations may have progressed over time, there was no evidence in the record from which to conclude the severity at separation approached that portrayed by the VA measurements.  There was no documentation of IVDS with incapacitating episodes which would provide for a higher rating under that formula.  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.   

Right Femoral Nerve Peripheral Neuropathy.  According to the STR and MEB NARSUM, the CI’s right femoral nerve peripheral neuropathy condition began in June 2003 without any specific injury or trauma.  On 14 July 2003 the CI complained of experiencing right lateral muscular numbness after driving his motorcycle. These right lateral quad problems were ongoing for 2 weeks.  Neurological evaluation on 29 March 2004 revealed normal SLR testing and normal iliopsoas, quadriceps, hamstrings, foot dorsiflexor and plantar flexor muscle strength.  He had a patch of relative analgesia to pain over his anterior and lateral right thigh.  His reflexes were equal and low back ROM was good.  The examiner’s impression was a peripheral type of neuropathy in the CI’s right leg.  Electrodiagnostic testing on 7 April 2004 revealed chronic radiculopathy affecting the right L4 and L5 nerve roots and underlying mixed axonal-demyelinating sensory motor neuropathy.  The neurosurgeon noted that although the CI had confirmed radiculopathy, he also had some peripheral neuropathy in his right leg causing the numbness.  He was directed to see a medical neurologist.  The 12 July 2004 MEB NARSUM examination, 2 months prior to separation, noted complaints of right leg paresthesia.  Physical examination did not address the right femoral nerve peripheral neuropathy.  

At the 11 January 2005 C&P evaluation the CI reported right thigh numbness since June 2003 while on leave; he denied trauma.  Physical examination showed an SLR test that did not produce a radiculopathy, sciatic nerve involvement, nor increase his right thigh paresthesia.  He did have a fairly numb right lateral thigh area, approximately 6 x 6 inches as compared to the left, where he could feel pressure, but no sharp sensation.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right femoral nerve peripheral neuropathy condition 10%, coded 5243-8726 (IVDS-anterior crural nerve (femoral) neuralgia).  The VA did not rate the right femoral nerve peripheral neuropathy condition because the CI did not file a disability claim for this condition.  

The CI reported right thigh paresthesia.  Electro-diagnostic testing revealed chronic radiculopathy affecting the right L4-L5 nerve roots with underlying mixed axonal demyelinating sensory and motor neuropathy.  A CT myelogram scan showed L4-L5 and L5-S1 DDD with mild disk bulging.  The source of pain was the L5 and S1 nerve roots which came off the same trunk and was directly over the bulging disc and pushed the nerve up into the joint.  Panel members considered whether the CI’s condition warranted a rating of 20% for “moderate” neuralgia.  

Although the CI experienced right thigh numbness and paresthesia he was allowed to walk, bike and swim at his own pace and distance, go to the gym for physical training, and perform administrative duties.  The VA examination recorded a negative SLR test which did not produce a radiculopathy, sciatic nerve involvement, nor an increase right thigh paresthesia.  There was insufficient evidence to support a higher “moderate” rating.  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 right femoral nerve peripheral neuropathy 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.  In the matter of the right femoral nerve peripheral neuropathy condition and IAW VASRD §4.124a, 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 20160927, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20180001948, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

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. 

A copy of this decision has been provided to the counsel you listed on your application, XXXXXXXXXXXXXXXXXX.

Sincerely,					      
Enclosure