RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02466
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070620

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Wheeled Vehicle Mechanic, medically separated for “right L5 radiculopathy” and “chronic low back pain,” rated 10% and 0%, respectively, with a combined disability rating of 10%.  

CI CONTENTION:  “All items on my VA rating...”   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 - 20070424	VARD - 20071010	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right L5 Radiculopathy 	5243-8620	10%	Chronic Low Back Pain with Radiculopathy	5237	10%	20070914	
Chronic Low Back Pain	5243	0%					
Neck Stiffness 	Not Unfitting	Cervical Disc Degeneration C3-4	5243	0%		
Bilateral Shoulder Impingement Syndrome	Not Unfitting	Right Shoulder Impingement	5201-5010	10%		
		Left Shoulder Impingement	5299-5201	NSC		
Right hip pain	Not Unfitting	Right hip pain	5253-5010	0%		
Bilateral Knee Pain	Not Unfitting	S/P Left Knee Arthroscopy	5259	0%		
		Right Knee Pain	5299-5257	NSC		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain with Right L5 Radiculopathy.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s back condition began in March 1998 without any known trauma.  Afterward, the CI had no significant back problems until he experienced paresthesias (tingling and/or numbness) of the bilateral anterior thighs in late 2001.  X-rays and MRIs at the time showed mild degenerative changes.  Thoracic spine X-rays in March 2006 showed degenerative changes involving the lower thoracic spine.  X-rays on 23 January 2007 demonstrated mild narrowing of the posterior aspect of the L5-S1 disk space and spina bifida occulta of S1. Electrodiagnostic studies on 26 January 2007 showed evidence of a right L5 radiculopathy. 

At an MEB consultation dated 31 January 2007, the CI complained of non-radiating low back pain and walked with a cane in his right hand with a somewhat antalgic gait on the right side.  He was able to flex at the waist without complaints of increasing amounts of pain.  There was tenderness over the lumbosacral junction.  He had negative straight leg raising (SLR) of the lower extremities.  Reflexes of the lower extremities were normal and he was able to both heel walk and toe walk without difficulty.  The examiner’s diagnosis was right-sided L5 sensorineural apraxia.  At a neurosurgery clinic visit on 5 February 2007, the examiner noted reflexes throughout and no motor weakness.  The examiner’s assessment was intervertebral disc degeneration (IVDS) causing chronic low back pain with mild right L5 radiculopathy.  There was no surgery indication. 

The 22 February 2007 MEB NARSUM examination, 4 months prior to separation, noted complaints of constant low back pain in the right lower spinal border.  Pain varied from 4-9/10 (10 being the worst pain).  Symptoms increased with prolonged standing, sitting, walking or bearing weight on the back and trunk.  Physical examination of the thoracolumbar spine showed full active range of motion (ROM) with pain at the end ranges of flexion and rotation.  There was no tenderness and no paravertebral muscle spasms.  Heel-to-toe walking was normal and SLR’s were negative.  Strength and reflexes in the lower extremities were normal, but there was decreased sensation of the bilateral anterior thighs to light touch.  

At the 14 September 2007 VA Compensation and Pension (C&P) examination, 3 months after separation, the CI reported constant 5/10 low back pain and bilateral thigh numbness with intermittent right leg numbness. Physical examination recorded active flexion to 90 degrees (normal) and combined ROM of 240 degrees (normal) after repetitive motion.  There was no decreased ROM due to pain, there were no spasms and IVDS was not noted.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right lower extremity radiculopathy 10%, dual coded 5243-8620 (intervertebral disc syndrome-sciatic nerve neuritis (equivalent to mild partial paralysis)), citing cane assisted antalgic gait without atrophy or weakness.  The PEB rated the back condition 0%, coded 5243 (intervertebral disc syndrome), citing normal spinal contour with full motion and without paraspinal muscle spasm or tenderness and no mechanical loss of motion.  The VA combined the radiculopathy and low back conditions into one single condition (chronic low back pain with radiculopathy) with a rating of 10%, coded 5237 (lumbosacral strain), based on the C&P examination, citing functional limitations caused by pain.  

Although there was insufficient limitation of motion of the thoracolumbar spine to support a 10% rating, the panel agreed a 10% rating was justified for the presence of painful motion (VASRD §4.59).  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.  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 radiculopathy and recommends a disability rating of 10% for the back condition, coded 5243. 

Contended PEB Conditions:  Neck Stiffness, Bilateral Shoulder Impingement Syndrome, Right Hip Pain and Bilateral Knee Pain.  The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting.  Of all of the contended conditions, only the right shoulder had a permanent U2 profile (see below). None of the conditions were implicated in the commander’s statement and none of the conditions failed retention standards.  

Bilateral Shoulder Impingement.  On 31 January 2007 the orthopedic clinic made the diagnosis of bilateral shoulder impingement syndrome and noted it met retention standards.  At the NARSUM examination, the CI had full active ROM bilaterally with pain at the end ranges with mild tenderness over the right acromioclavicular joint without deformity.  Strength was normal bilaterally.  At a VA orthopedic surgery consultation on 13 March 2008, 9 months after separation, the CI reported long standing right shoulder pain for which he received cortisone injections in the past.  Flexion was 170 degrees (normal 180) without pain.  There was no instability.  There was no performance-based evidence from the record that any of the contended conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions, so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the right radiculopathy and IAW VASRD §4.124a, the panel recommends no change in the PEB adjudication.  In the matter of the back condition, the panel recommends a disability rating of 10%, coded 5243 IAW VASRD §4.71a.  In the matter of the contended neck, bilateral shoulder, right hip and bilateral knee conditions, the panel recommends no change from the PEB determinations as not unfitting.  There are no other conditions within the panel’s scope of review for consideration.  

The panel recommends the CI’s prior determination be modified as follows, effective the date of medical separation: 

CONDITION	VASRD CODE	PERMANENT RATING	
Right L5 Radiculopathy 	5243-8620	10%	
Chronic Low Back Pain	5243	10%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170311, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR20190007898, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX

The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	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 also been provided to the Department of Veterans Affairs.

Sincerely,				       

Enclosure