RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXX  	CASE:  PD-2017-03140
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070505

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a National Guard E5, Wheeled Vehicle Mechanic, medically separated for “lumbar degenerative disc disease” and “left L5-S1 leg radiculopathy,” rated 10% each, with a combined disability rating of 20%.  

CI CONTENTION:  “I have a bone spur penetrating my nerve in my left leg.  They refused to do surgery.”  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 - 20070330	VARD - 20080429	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Lumbar Degenerative Disc Disease	5299-5242	10%	Lumbar Strain, Status Post Micro Discectomy	5243	10%	20080226	
Left L5-S1 Leg Radiculopathy 	8520	10%	Left L5-S1 Radiculopathy	8599-8520	10%	20080226	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Lumbar Degenerative Disc Disease.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s low back condition began in December 2005 after he slipped and fell.  In June 2006, the CI consulted with a neurosurgeon and was advised that his condition was not a surgically correctable problem.  Lumbar spine MRI in July 2006 showed a disc bulge at L4-5 causing mild spinal stenosis.  There was mild degenerative disc disease without stenosis at L3-4, and no neurforaminal narrowing at any level.  

The 24 January 2007 MEB NARSUM examination, 3 months prior to separation, noted complaints of intermittent back and leg pain preventing the CI from performing his MOS duties as a mechanic.  Pain symptoms worsened with cold weather.  Physical examination showed a scar from previous back surgery.  There was marked sciatic notch tenderness.  Sensation of the lower back was intact.  Range of motion (ROM) testing, after repetition, showed painful flexion of 70 degrees (normal 90) and combined ROM of 220 degrees (normal 240).  

At the 26 February 2008 VA Compensation and Pension (C&P) examination, 10 months after separation, the CI reported chronic low back pain, numbness and weakness in the left leg. Physical examination revealed tenderness of the lumbar spine and muscle spasms that did not result in abnormal gait or abnormal spinal contour.  Thoracolumbar spine ROM noted painful flexion to 75 degrees and combined ROM of 195 degrees.  There was no additional ROM loss due to pain, fatigue, weakness, lack of endurance or incoordination following repetitive use.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, analogously coded 5242 (degenerative arthritis of the spine), citing: “Without significant motor neurological deficit; rated for localized tenderness.”  The VA also rated the back condition 10%, coded 5243 (intervertebral disc syndrome), based on the C&P examination, citing forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees or, combined ROM of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees or for muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour.  

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/or combined ROM (greater than 120 degrees but not greater than 235 degrees), as reported on the MEB NARSUM and VA examinations.  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.  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.  

Left L5-S1 Leg Radiculopathy.  According to the STR and MEB NARSUM, the CI’s left L5-S1 radiculopathy condition began in December 2005 after the above noted accident.  The March 2006 electrodiagnostic study of the left lower extremity documented no evidence of radiculopathy or neuropathy or entrapment, but the December 2006 electrodiagnostic study showed active L4-5 radiculopathy on the left.  

The MEB NARSUM examination noted complaints of left leg pain with numbness and tingling.  His pain traveled from his lower back into the left buttock and down the back of the left leg as far as the toes.  The numbness and tingling traveled in the same distribution down the left leg.  Physical examination showed decreased light touch sensation down the back of the left lower extremity as far as the toes consistent with L5-S1 radiculopathy.  Motor strength was 4/5 on the left lower extremity and 5/5 on the right.  The CI was able to elevate his leg against resistance and could hold his leg up against gravity.  

At the C&P examination the CI reported left leg pain, numbness, weakness and tingling.  Physical examination showed decreased sensation to light touch and pinprick in the foot and lateral leg below the knee.  The electrodiagnostic study showed no evidence of acute lumbar or sacral radiculopathy involving the left lower extremity.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the radiculopathy 10%, coded 8520 (sciatic nerve, paralysis of), citing motor strength of 4/5.  The VA also rated the radiculopathy 10%, analogously coded 8520, based on the C&P examination, citing negative electrodiagnostic findings; however, there was clinical evidence of left L5-S1 radiculopathy with mild incomplete paralysis.  The panel agreed that a 10% rating, and no higher, was justified for mild symptoms manifested by mild sensory changes and slight decrease in motor strength. The higher rating of 20% for moderate disability was not supported based on absence of significant muscle weakness.  The CI was able to elevate his leg against resistance and could hold his leg up against gravity.  There was no evidence of decreased ambulation due to foot or leg fatigue, thus, the next higher rating was not justified on this basis.  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 left lower extremity 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 left lower extremity 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:  

[AR NUMBER], XXXXXXXXXXXXXXXX 

Dear XXXXXXXXXXXXXX

	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.

Enclosure