RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02650
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080327

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Chemical Operations Specialist, medically separated for “intervertebral disk syndrome, lumbar spine,” and “lumbar right radiculopathy,” each rated 10%,  with a combined  disability rating of 20%.  

CI CONTENTION:  In addition to the back and right radiculopathy, the CI requested review of an additional condition not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB).  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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the 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 - 20080426	VARD - 20080519	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Intervertebral Disk Syndrome, Lumbar Spine	5243	10%	Intervertebral Disk Syndrome, Lumbar Spine	5243	0%	STR	
Lumbar Right Radiculopathy 	5243-8720	10%	Radiculopathy of the Right Lower Extremity	8620	0%	STR	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Intervertebral Disk Syndrome, Lumbar Spine.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s back condition began in November 2005 after falling from the top of an M1 tank.  An MRI at that time indicated a herniated nucleus pulposus in the lumbar spine.  A subsequent June 2007 MRI revealed mild disk height loss and disk desiccation at L5-S1 with associated tiny posterior annular fissure and mild degenerative disk disease from L2 through L-5.  He was not a surgical candidate.

During the 31 October 2007 MEB NARSUM examination, 5 months prior to separation, the CI complained of low back pain.  Physical examination showed tenderness, but no spasms and gait and spinal contour were normal.  The physical therapy range of motion (ROM) evaluation for the MEB showed thoracolumbar flexion of 80 degrees (normal 90) and combined ROM of 215 degrees (normal 240), after repetition, with painful motion.  There was no VA examination proximate to separation in evidence.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, coded 5243 (intervertebral disc syndrome), citing pain-limited motion and localized tenderness.  The VA rated the back condition 0%, coded 5243, based on the STR, citing no current evidence on the severity of the condition. Panel members 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.  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.  

Lumbar Right Radiculopathy.  According to the STR and MEB NARSUM, the CI’s right radiculopathy began concurrent with the above listed back condition.  The June 2007 MRI of the lumbar spine showed a protruding disc at L5-S1 and contributed to mild bilateral neural foraminal encroachment.  At the 23 July 2007 neurosurgery examination, 8 months prior to separation, the CI reported right whole leg numbness.  Physical examination revealed negative straight leg test bilaterally, mild right lower extremity weakness (4+/5), effort dependent, and a 35% reduction in tactile stimulation of the entire right leg.  Right ankle reflex was absent or diminished.  Electrodiagnostic studies (EMG) performed on 17 October 2007 was normal, with no evidence of a right lumbar radiculopathy.

The MEB NARSUM examination noted complaints of constant, throbbing "pins and needles" pain and right lower extremity numbness.  He also reported daily incapacitating severe knife-like pain made worse with going up-and-down stairs, prolonged walking, moving over uneven terrain or from lifting heavy objects.  Physical examination showed decreased sensation to light touch to the entire right leg and manual muscle testing of the lower extremities indicated 4/5 weakness in the right hip flexors and knee extensors that was effort dependent.  Bilateral Achilles tendon reflexes were absent.  Straight leg raise testing was negative.

During the 25 March 2008 neurology visit, 2 days prior to separation, the CI complained of diffuse right leg paresthesias.  Physical examination recorded normal gait, tone and strength throughout all limbs.  Sensation was reduced throughout the right leg without a clear neuropathic or radicular pattern.  The examiner opined the pattern of the sensory deficit did not suggest a radiculopathy.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right radiculopathy 10%, dual coded 5243-8720 (intervertebral disc syndrome – sciatic nerve), citing mild incomplete paralysis due to diminished right Achilles reflex with some pain-limited weakness.  The VA rated the right radiculopathy 0%, coded 8260 (neuritis), based on the STR, citing no current evidence of the severity of the condition.  The panel agreed that a 10% rating, but no higher, was justified under the analogous 8720 coding.  The neurosurgery consult, NARSUM and neurology examinations all showed absence of or deficits of Achilles reflex, but no consistent finding of sensory deficit.  The EMG was normal and showed no evidence of radiculopathy.  Panel members agreed a higher rating was not achievable under any of the lower extremity nerve codes given the absence of muscle atrophy or objective evidence of a radiculopathy with significant functional impairment.  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 right radiculopathy.  

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 right radiculopathy and IAW VASRD §4.124a, 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 20170318, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR20190006131, 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.