RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01774
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20051212

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Aircraft Structural Repairman, medically separated for “L5-S1 herniated nucleus pulposus” with a disability rating of 10%.  “Wolff-Parkinson-White [WPW] syndrome” was determined to have existed prior to service (EPTS) and was not rated.  

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 – 20050919	VARD - 20061017	
Condition	Code	Rating	Condition	Code	Rating	Exam	
L5-S1 Herniated Nucleus Pulposus	5243	10%	L5-S1 Disk Herniation	5243	40%	20060718	
WPW Syndrome	7013	EPTS	WPW Syndrome	7099-7011	0%	20060718	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

L5-S1 Herniated Nucleus Pulposus.  According to the service treatment record (STR) and the MEB narrative summary (NARSUM), the CI’s back condition began insidiously in January 2005.  A lumbar MRI showed a moderate size posterior herniated disc at L5-S1 causing some narrowing in the left neural foramen, a mild bulging disc at the L4-L5 disc level, and mild degenerative joint disease in the facet joints of the vertebrae.  At a neurosurgical evaluation on 18 July 2005 the CI reported low back pain extending into the left buttock and into the left leg to the calf.  On examination, the thoracic and lumbar spines were normal, but there was tenderness and also pain with lumbar range of motion (ROM).  Strength, sensation, and reflexes were normal, he was able to walk on his heels and his toes, and he had a negative straight leg raise (to determine nerve root irritation).  X-rays of the lumbar spine demonstrated mild subluxation at the L4-L5 level.  Electrodiagnostic studies on 15 August 2005 revealed a mild left radiculopathy.  

The 9 August 2005 MEB NARSUM examination, 4 months prior to separation, noted complaints of mid-lower back pain that traveled down the left leg to the calf and was aggravated by running, bending, squatting, or other exercises.  Physical examination showed tenderness, but no significant muscle spasms.  Straight leg raising testing was positive on the left with pain in the buttock and thigh.  There were no neurosensory changes in the lower back and lower extremities.  Gait and reflexes were normal.  Thoracolumbar ROM showed forward flexion of 65 degrees (normal 90) and combined ROM of 175 degrees (normal 240), limited by pain.  

At the 18 July 2006 VA Compensation and Pension (C&P) examination, 7 months after separation, the CI reported severe weekly back flare-ups lasting an average of 4-7 days.  Aggravating factors were overexertion, bending, and twisting.  Physical examination showed normal posture and gait, but there were spasms.  There was no evidence of kyphosis, lordosis, or scoliosis.  He exhibited no fatigue, but displayed moderate stiffness in the lower back and mild weakness in the left lower extremity.  Thoracolumbar ROM showed forward flexion of 30 degrees (normal 90) and combined ROM of 130 degrees (normal 240) with painful motion.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, coded 5243 (intervertebral disk syndrome (IVDS)), citing thoracolumbar ROM limited by pain with localized tenderness.  The VA rated the back condition 40%, coded 5243, based on the C&P examination, citing forward flexion limited to 30 degrees.  

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) and combined ROM (greater than 120 degrees but not greater than 235 degrees) as reported on the NARSUM examination, 4 months prior to separation.  Members noted the VA rating of 40% was based on forward flexion of 30 degrees, 7 months after separation; however, there was no indication of an accident, injury, or surgery.  Therefore, members determined the probative value of the NARSUM examination prior to separation was greater than the VA examination.  There was no documentation of IVDS with incapacitating episodes which would provide for a higher rating under that formula.  After due deliberation, considering all 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 back 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 and there were symptoms of radiating pain documented in the treatment records; however, examinations indicated normal strength, reflexes, and gait.  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.  

Wolff-Parkinson-White (WPW) Syndrome.  According to the STR and MEB NARSUM, the CI’s heart condition began insidiously in March 2005 with an acute onset of chest discomfort in the upper chest.  An electrocardiogram showed type B Wolff-Parkinson pattern and it was noted that the CI had a history of WPW syndrome noted on a pre-service electrocardiogram in 1997.  The CI had cardiac arrhythmias that presented as palpitations, but became evident to medical personnel and were confirmed by electrocardiograph findings.  In order to remain in service an ablation was performed; however, post ablation the supraventricular arrhythmias marked by palpitations recurred.  Therefore, the evidence was clear and unmistakable that there was no service aggravation beyond the condition’s natural course.  After due deliberation, considering all 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 Wolff-Parkinson-White syndrome condition.  

BOARD FINDINGS:  In the matter of the back condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the Wolff-Parkinson-White syndrome and IAW VASRD §4.104, the panel 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 20170228, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180008642, 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