RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-04508
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060304

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a National Guard E5, M1 Armor Crewman, medically separated for “chronic low back pain secondary to degenerative disc disease L4/LS, L5/S1” with a disability rating of 10%.  

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 - 20060210	VARD - 20061130	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain…	5243	10%	Degenerative Disc Disease, Lumbosacral Spine, L4-5 & L5- S1	5243	10%	20060818	
Obstructive Sleep Apnea	Not Unfitting	Sleep Apnea	6847	50%	20061003	
Bilateral High-Frequency Hearing Loss	Not Unfitting	Bilateral Hearing Loss	6100	0%	20060731	
Left Interosseous Nerve Syndrome Post-Surgical Decompression with Residual Paresthesia	Not Unfitting	Anterior Interosseous Nerve Syndrome, Left Upper Extremity, Status Post-Surgical Release	8615 	10%	20060814	
Right Meralgia Paresthetica	Not Unfitting	Meralgia Paresthetica, Right	8529	10%	20060814	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  80%  	

ANALYSIS SUMMARY:  

Chronic Low Back Pain (LBP).  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s low back condition began in January 2005 a few days after a sandbag detail while deployed.  An MRI indicated an L4-5 and L5-S1 disc herniation with compression of the right S1 nerve root.  Despite medications, but the pain persisted, and in physical medicine on 19 May 2005, he reported numbness in the distribution of the right lateral femoral cutaneous nerve.  Motor and reflex findings were normal and electrodiagnostic testing showed no signs of right lower extremity radiculopathy.  In neurosurgery the same day, he was observed to have decreased reflexes on the left compared to the right, but could move comfortably with normal motor functioning.  He was diagnosed with right meralgia paresthetica (peripheral neuropathy from compression of the lateral femoral cutaneous nerve).  On 19 July 2005, the CI was seen again in neurosurgery, and noted to have normal ROM, motor function, and reflexes, however sensation was reduced on the right in an L1 and L2 distribution.  Medications, duty limitations, and physical therapy did not relieve the pain.  

During the 29 September 2005 MEB examination (recorded on DD Forms 2807-1 and 2808), 5 months prior to separation, the CI reported right thigh numbness.  Physical examination revealed a normal spine, but neurological findings were abnormal for decreased sensation of the left thumb, and the examiner noted a history of right thigh radiculopathy due to “lumbar hernia.”  A repeat MRI on 4 November 2005 showed persistent disc herniation as previously noted.  The 16 November 2005 MEB NARSUM examination, 4 months before separation, recorded complaints of LBP that interfered with duty. It was noted that several neurosurgeons recommended against surgery and that a neurosurgical evaluation 1 week earlier (not in evidence) had determined that the lower extremity pain was not radicular.  Physical examination revealed lumbosacral spine tenderness, and normal thoracolumbar spine contour.  The examiner referenced thoracolumbar ROM measurements performed by physical therapy on 18 October 2005, which showed flexion of 80 degrees (normal 90) and combined ROM of 185 degrees (normal 240), after repetition and limited by pain.  Repeat electrodiagnostic testing on 17 January 2006 showed bilateral L5-S1 radiculopathies, and a neurology evaluation 2 weeks later noted that the CI had central canal and foraminal narrowing which could cause the radicular findings. Gait was normal with symmetric limb movement.  

At the 14 August 2006 VA Compensation and Pension (C&P) neurology examination, 5 months after separation, the CI reported LBP which radiated to the lower extremities. He was able to forward flex with fingers within 3 inches of the floor, and gait, reflex, and motor examinations of the lower extremities were normal.  Sensation was reduced over the right lateral femoral cutaneous nerve and in a stocking distribution (both non-radicular).  Four days later at the C&P orthopedic examination, the CI reported constant sharp pain aggravated by activity.  Physical examination showed a normal gait without use of an assistive device, and no significant loss of lumbar lordosis.  There was moderate tenderness to palpation, and the examiner noted that the CI shifted his position frequently.  Repetitive lumbar ROM measurements showed flexion of 45 degrees (onset of pain), and combined ROM of 185 degrees, limited by pain.  Sensation was reduced bilaterally in an L5-S1 distribution, but reflex and motor examinations were normal.    

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back condition 10%, coded 5243 (intervertebral disc syndrome), citing range of motion limited to 85 degrees by pain.  The VA also rated the low back condition 10%, coded 5243, based on the C&P examination, citing “findings on the medical board report support a 10 percent evaluation for the low back.”  Panel members observed that the C&P orthopedic examination was an outlier from other evaluations and also apparently stopped at the onset of pain, rather than the limit of motion.  It was therefore assigned a lower probative value and not used for rating purposes.  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 NARSUM examination proximate to separation.  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 low back condition.  

Contended PEB Conditions:  Obstructive Sleep Apnea (OSA), Bilateral High-Frequency Hearing Loss, Left Interosseous Nerve Syndrome Post Surgical Decompression with Residual Paresthesia, Right Meralgia Paresthetica.  The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting.  The OSA was diagnosed and profiled after a sleep study was done in January 2006, while the CI was going through the MEB process.  Although the OSA did not meet retention standards, it was not implicated in the commander’s statement and there was no performance-based evidence from the record that it significantly interfered with satisfactory duty performance at separation. 

While the bilateral high-frequency hearing loss was also profiled, it and the remaining conditions were not implicated in the commander’s statement and did not fail retention standards.  There was no performance-based evidence from the record that any these 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 low back condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended obstructive sleep apnea, bilateral hearing loss, left interosseous nerve syndrome, and right meralgia paresthetica, 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.  Therefore, the panel recommends no modification or re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

AR20190007301, 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.