RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	 cASE:  PD-2017-04501
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060530

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Helicopter Repairman, medically separated for “low back pain” and “right lower extremity pain” each rated 10%, 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 - 20060310	VARD – 20060821	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Low Back Pain	5243	10%	IVDS, Lumbar Spine	5243	20%	20060703	
Right Lower Extremity Pain	8720	10%	Sciatica, Right Lower Extremity	8620	10%	20060703	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Low Back Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s low back condition began in May 2005 after heavy lifting.  He experienced sharp shooting pain down the right side of the leg and pain in the low back.  An MRI revealed a disc protrusion at L4-5 and herniation at L5-S1.  He developed right sided radiculopathy manifested by pain and sensory changes.  Surgery was considered, but not recommended.  

In pain management on 6 September 2005, the CI had a normal (implied) neurological examination and normal lumbar curvature.  A provocative test for nerve root irritation was positive, but numbness, tingling and weakness were denied.  The gait showed no significant deficits.  Ten days later in orthopedics, the CI reported pain that radiated to the back of the knee.  The range of motion (ROM) evaluation showed flexion limited to approximately 30 degrees (normal 90), side bending to approximately 20 degrees and rotation to approximately 20-25 degrees.  Strength and sensation were normal.  Reflexes were decreased, but symmetrically (non-radicular).  He was thought to be showing resolution and surgery was not considered beneficial at that time.  

In flight medicine on 25 October 2005, sensation was reduced on the right in the L5 dermatome, but strength was intact.  Reflexes were symmetrically diminished.  Provocative testing for nerve root irritation was negative.  Tenderness was present over the L5-S1 region.  On follow up 6 weeks later on 1 December 2005, the CI reported pain radiating down the right lower extremity.  The examiner noted the CI appeared uncomfortable.  Spasm was present on examination.  Lumbosacral flexion was noted to be painful, but limitation in motion not documented.  Motion was otherwise normal.  The neurological examination and gait were normal.  

During the 7 February 2006 MEB NARSUM examination, 4 months prior to separation, the CI reported that he enjoyed camping, hunting and fishing.  He had stopped medications and reported that physical therapy aggravated his back pain.  The ROM evaluation showed flexion of 30 degrees.  Extension and lateral rotation were normal.  The neurological examination was normal with the exception of symmetrically decreased reflexes.  Provocative testing for nerve root irritation was positive on the right.  Gait and stance were normal.  

At the 3 July 2006 VA Compensation and Pension (C&P) examination, 1 month after separation, the CI reported back pain traveling down his right leg.  The CI claimed a total of 3 days of incapacitation over the prior year.  He was able to do all activities of daily living including gardening and pushing a lawn mower.  Physical examination showed the CI in no acute distress.  Tenderness was present but spasm was not.  Provocative testing for nerve root irritation was present on the right, but there was no evidence of radiating pain with movement.  Thoracolumbar ROM measurements showed painful flexion of 50 degrees and combined ROM of 200 degrees (normal 240).  Repetitive motion caused no additional limitation.  The gait, posture and spinal contour were normal and no assistive device was in use.  The neurological examination was normal.  There were no signs of intervertebral disc syndrome (IVDS) with chronic and permanent nerve root involvement.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back condition 10%, coded 5243 (IVDS), citing limitation due to pain, non-deforming muscle spasm and paraspinal tenderness.  The VA rated the back condition 20%, coded 5243, based on the C&P examination, citing forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees.  The panel noted that the limitation to 30 degrees of flexion on the NARSUM was not consistent with the recorded normal gait or level of activity reported by the CI.  The C&P examination was therefore assigned a higher probative value and supported the 20% rating adjudicated by the VA.  After due deliberation, consideration all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 20% for the back condition, coded 5243.  

Right Lower Extremity Pain.  The history and examinations for the right lower extremity condition are recorded above.  The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right lower extremity condition 10%, coded 8720 (neuralgia, sciatic nerve), citing mild incomplete paralysis.  The VA also rated the right lower extremity condition 10%, coded 8620 (neuritis, sciatic nerve), based on the STR and C&P examinations, citing incomplete paralysis below the knee which was mild.  The panel considered the evidence.  The neurological examination was noted to be normal on the examinations proximate to separation.  Reflexes were diminished, but symmetrically which is not a finding of radiculopathy.  Provocative testing for nerve root irritation was positive on some, but not all, examinations.  The VA examiner specifically noted that the CI had no signs of IVDS or permanent nerve root involvement.  While pain was reported on multiple examinations, it is subsumed under the rating for the back condition above.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 0% for the right lower extremity condition, coded 8720.  The panel noted that the combined rating of the two conditions remained 20% providing no advantage to the CI.  Accordingly, no change in the PEB adjudication 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 right lower extremity condition 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], XXXXXXXXXX

Dear XXXXXXXXXX:

	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.