RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01037
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20080227

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Satellite Communication Systems Operator and  Maintainer, medically separated for “neuritis of right S-1 root” with a disability rating of 20%.  

CI CONTENTION:  “Review 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 Medical Evaluation Board (MEB), but determined by the PEB 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.  The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence relevant to application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards for 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, which operates 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 disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20070113	VARD - 20080430	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Neuritis of Right S-1 Root	5243-8620	20%	Status Post Lumbar Spine Microdiscectomy	5242	20%	20080211	
Mild High Frequency Loss, Left Ear	Not Unfitting	Tinnitus	6260	10%	20080218	
Hyperlipidemia	Not Unfitting	No VA Placement				
Hypertension	Not Unfitting	Hypertension	7101	0%	20080211	
Gastroesophageal Reflux Disease	Not Unfitting	Gastroesophageal Reflux Disease	7346	10%	20080211	
Headache Syndrome	Not Unfitting	Chronic Headaches  	8100	0%	20080211	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Neuritis of Right S-1 Root.  According to the service treatment record (STR) and MEB) narrative summary (NARSUM), the CI underwent back surgery with microdiscectomy in March 2006 for a herniated disc.  On 5 June 2007, a nerve conduction study was noted to be compatible with a right S1 distribution radiculopathy, with both acute and chronic type degenerative changes.  
During the 3 October 2007 MEB NARSUM examination, 5 months prior to separation, the CI reported sharp lower back pain, numbness and tingling in the right posterior thigh radiating to the lower leg and right foot.  The examiner noted normal gait and posture with no tenderness, spasm or spinal deformity.  There was an absence of the right Achilles tendon reflex and sensation to light touch was decreased over the right lower leg and foot, but motor strength was normal in the lower extremities.  Provocative testing to elicit radicular signs was negative bilaterally.  The examiner documented forward flexion to 80 degrees (normal 90) and a combined ROM of 215 degrees (normal 240).  

During the 11 February 2008 VA Compensation and Pension (C&P) evaluation 2 weeks before separation, the CI reported stiffness, spasms, and sharp pain.  He also reported right lower extremity numbness and tingling with standing or walking long distances.  The CI stated that his condition had not resulted in any incapacitation.  The examiner noted normal posture, gait, motor strength, reflexes and sensation in the lower extremities bilaterally and provocative testing to elicit radicular signs was negative.  There was no evidence of radiating pain on movement.  Muscle spasm was present, but there was no tenderness.  The ROM examination showed forward flexion of 60 degrees and combined thoracolumbar ROM of 210 degrees.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the neuritis condition 20%, coded 5243-8620 (intervertebral disc syndrome (IVDS) causing neuritis of the sciatic nerve), citing the condition was equivalent to moderate incomplete paralysis because of associated loss of ankle reflex and sensory disturbances.  The VA rated the neuritis condition 20%, coded 5242, (degenerative arthritis of the spine), based on the C&P examination 2 weeks before separation, citing painful forward flexion to 60 degrees.  

The panel first considered the somewhat disparate examinations and found the VA C&P examination to have the highest probative value for rating purposes because it was complete (addressed all potential rating possibilities), it was prior to separation and it was most proximate to separation.  The panel next considered the options for rating the CI’s condition.  The panel agreed that a 20% rating, but no higher, was justified for limitation of flexion greater than 30 degrees but not greater than 60 degrees as reported on the VA examination.  There was no evidence of intervertebral disc syndrome (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 panel next considered if additional disability rating was justified for peripheral nerve impairment due to radiculopathy.  The CI had a herniated disc with radicular pain treated with surgery, and there were symptoms of radiating pain documented in the treatment records; however, the VA examination indicated normal motor strength, reflexes, gait and sensation.  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 that there was insufficient cause to recommend a change in the PEB adjudication for the neuritis condition.  

Contended PEB Conditions:  Mild High Frequency Hearing Loss, Left Ear; Hyperlipidemia; Hypertension; Gastroesophageal Reflux Disease; and Headache Syndrome.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  None of the conditions were profiled, implicated in the commander’s statement nor judged to fail retention standards.  There was no performance-based evidence from the record that any of the conditions significantly interfered with satisfactory duty performance at separation.  The panel also notes that hyperlipidemia is an abnormal lab finding and not a ratable condition under the VASRD.  After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:

In the matter of the neuritis condition and IAW VASRD §4.124a, the panel recommends no change in the PEB adjudication.  In the matter of the contended mild high frequency hearing loss, left ear; hyperlipidemia; hypertension; gastroesophageal reflux disease; and headache syndrome conditions, the panel unanimously recommends no change from the PEB determinations as not unfitting.  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 20170221, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20180004924, 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.

Sincerely,					      
Enclosure