RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-04073
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20081123

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E7, Wheeled Vehicle Mechanic, medically separated for “degenerative arthritis, lumbar spine” and “left sciatic nerve injury,” rated 10% each, with a combined 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 - 20080814	VARD - 20090225	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Lumbar Spine Degenerative Arthritis 	5242	10%	Lumbar DDD	5010-5242 	10%	20081020	
Left Sciatic Nerve Injury	8520	10%	Left Leg Radiculopathy	8599-8520	NSC	20081020	
Right Lower Extremity Denervation	Not Unfitting 	Right Leg Radiculopathy	8599-8520	NSC	20081020	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Lumbar Spine Degenerative Arthritis.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s back condition began in 1997 without injury or trauma.  An MRI showed severe ligamentum flavum hypertrophy constricting the spinal cord and nerves at L5-S1 and L4-L5, left greater than right.   

During the 28 April 2008 MEB examination (recorded on DD Forms 2807-1 and 2808), 7 months prior to separation, the CI reported recurring back pain.  Physical examination showed paraspinal tenderness and limited range of motion (ROM) with decreased flexion, extension, lateral flexion and rotation.  At a 19 May 2008 physical therapy (PT) examination, 6 months prior to separation, the CI reported daily 7/10 back pain lasting 5-6 hours.  Physical examination revealed ROM measurements of painful flexion at 65 degrees (normal 90) and combined ROM of 190 degrees (normal 240), after repetition.  The 29 May 2008 MEB NARSUM examination, 6 months prior to separation, noted complaints of constant low back pain radiating from the side to her lower back.  Physical examination showed some paraspinal muscle spasm, tenderness and a mildly antalgic gait.  

At the 20 October 2008 VA Compensation and Pension (C&P) examination, one month before separation, the CI reported constant 8/10 lower back pain with radiation to the back of the bilateral thighs, legs, and feet with numbness and tingling.  Physical examination showed moderate tenderness over the lower lumbar spine area and a normal gait.  Straight leg raise test was positive bilaterally.  ROM testing showed painful flexion of 70 degrees and combined ROM of 200 degrees (normal 240) with pain after repetition.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, coded 5242 (degenerative arthritis of the spine), citing decreased sensation, tenderness, spasm, decreased flexion of 67 degrees and decreased combined ROM of 190 degrees.  The VA also rated the back condition 10%, coded 5010-5242 (traumatic arthritis-degenerative arthritis of the spine), based on the C&P examination, citing X-ray evidence showing degenerative changes and forward flexion at 80 degrees reduced to 70 degrees with repetitive motion.  

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 PT and VA examinations.  Although the NARSUM examination, 6 months prior to separation, showed spasm and an antalgic gait, which would support a 20% rating, the panel awarded more probative value to the VA examination, which showed a normal gait and no spasm, because it was most proximate prior to separation.  There was no documentation of intervertebral disc syndrome 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.  

Left Sciatic Nerve Injury.  According to the STR and MEB NARSUM, the CI’s left sciatic nerve condition began in June 2007.  The CI denied any specific injury or trauma.  A 30 October 2007 MRI showed L4-L5 disc osteophyte complex that caused moderate to severe lateral recess narrowing and displacement of the exiting nerve root on the left without significant central canal stenosis or neuroforaminal narrowing.  A 20 November 2007 examination showed elements of nerve root compromise on the left greatest at L5.  Prior nerve conduction studies were consistent with early neuropathy.  As noted above, a subsequent MRI showed severe ligamentum flavum hypertrophy constricting the spinal cord and the nerves at L5-S1 and L4-L5.  

An 18 April 2008 specialty evaluation, 7 months prior to separation, noted complaints of a 10- month history of numbness and tingling in the dorsal aspect of her feet at her toes and calves.  She denied any complaints of pain, numbness or tingling to her thighs, groin or buttocks.  She stated that she was avidly "working out" including work on the elliptical machine and the total gym.  Physical examination showed she had good muscle tone and mass bilaterally symmetrical without atrophy.  She had a normal gait without shuffling, leg lag, scissoring or staggering and her strength was 5/5 throughout the lower extremities.  

The MEB NARSUM examination noted complaints of constant numbness and tingling in her feet radiating up to the lower legs into the knees left greater than right with muscle spasms in the lower back and in the calf muscles.  Physical examination showed some paraspinal muscle spasm, tenderness, and a mildly antalgic gait.  

At the C&P examination the CI complained of back pain radiating to the back of the bilateral thighs, legs, and feet with numbness and tingling.  Physical examination showed positive straight leg raise testing bilaterally.  All muscles bilateral groups of the lower extremities had normal tone and power.  No muscle atrophy was noted.  Bilateral knee and ankle reflexes were normal as was gait.  Touch and pain sensation was found to be normal over bilateral lower extremities.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left sciatic nerve condition 10%, coded 8520 (incomplete mild paralysis of sciatic nerve), citing weakness of foot.  The VA determined the left sciatic nerve condition was not service connected.  

The panel considered if a disability rating was justified for peripheral nerve impairment due to radiculopathy.  The CI had moderate to severe lateral recess narrowing and displacement of the exiting nerve root on the left with numbness and tingling treated conservatively.  However, examinations indicated normal strength and gait, the sensory changes did not affect her job, and the CI was able to exercise regularly.  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 unfitting.  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 a disability rating was not justified on this basis.  However, the panel cannot recommend a lower disability rating than that adjudicated by the PEB.  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 sciatic nerve condition.  

Contended PEB Condition:  Right Lower Extremity Denervation.  The panel’s main charge is to assess the fairness of the PEB determination that the contended condition was not unfitting.  The contended condition was profiled and judged to fail retention standards, but was not implicated in the commander’s statement.  After review of the STR, there was no performance-based evidence from the record that the condition 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 the contended condition, so no additional disability rating is recommended.  

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 sciatic nerve condition and IAW VASRD §4.124a, the panel recommends no change in the PEB adjudication.  In the matter of the contended right lower extremity denervation condition, the panel recommends no change from the PEB determination 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.  

AR20180016609, 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.