RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-04543
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090922

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6, Cavalry Scout, medically separated for “intervertebral disc syndrome, L5-S1” and “left lower extremity radiculopathy,” 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 - 20090624	VARD - 20120926	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Intervertebral Disc Syndrome, L5-S1	5243	10%	Lumbar Strain with Muscle Spasms	5237	10%	20120711	
Left Lower Extremity Radiculopathy	8599-8520	10% 					
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  60% 	

ANALYSIS SUMMARY:  

Intervertebral Disc Syndrome.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s low back condition began in the summer of 2008 during a train-up for deployment.  X-rays and bone scan were negative, but MRI showed a herniated disk at L5-S1 with left foraminal stenosis.  The CI was not a surgical candidate.

The 30 April 2009 MEB NARSUM examination, 5 months prior to separation, noted complaints of daily pain and flares.  The flares were completely independent of activity and were associated with tingling down his left leg.  Bowel or bladder functions were not compromised.  Physical examination showed a normal gait, no abnormal contour of the spine, and no appreciated spasms.  There was tenderness on the left paraspinal area, and straight leg raise was positive on the left.  Range of motion (ROM) testing recorded forward flexion of 85 degrees (normal 90) and extension of 20 degrees (normal 30).  Painful motion during ROM testing was not addressed.  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 limitation of motion.  Panel members agreed, a 10% rating and no higher was justified for limitation of flexion (greater than 60 degrees but not greater than 85 degrees) as reported on the NARSUM examination.  There was no documentation of intervertebral disc syndrome (IVDS) with incapacitating episodes which would provide for a higher rating under that formula.  After due deliberation, considering all of 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 Lower Extremity (LLE) Radiculopathy.  According to the STR and MEB NARSUM, the CI began to experience LLE radicular symptoms associated with the low back condition in 2008 during a train-up for deployment as noted above.  At the 30 April 2009 MEB NARSUM, the CI reported that when he had low back pain flares, he would also experience tingling down his left leg.  He had no bowel or bladder dysfunction.  Physical examination showed normal deep tendon reflexes, and normal gait.  The LLE strength was decreased to 3+/5 during knee extension, due to pain, with decreased sensation to light touch of the LLE from the knee down to the foot.   

During the 19 June 2009 physical medicine evaluation for radiculopathy, 3 months before separation, the CI complained of easy fatigue of the left leg and decreased sensation over the lateral aspect distal to the knee.  Focused examination showed no evidence of atrophy or fasciculation.  He had normal strength in both lower extremities.  Gait and stance were normal.  Electrodiagnostic testing documented findings consistent with a left L5 radiculopathy.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the lower extremity radiculopathy 10%, analogously coded 8520 (sciatic nerve, paralysis of), citing mild, incomplete paralysis, due to limited endurance and ability to wear IBA.  A VA claim for a radiculopathy was not evident.  

Since there was no evidence of muscle atrophy in the lower left extremity that would reflect significant muscle fatigue or weakness, the panel agreed a 10% rating and no higher was justified for mild impairment under 8520.  Although muscle strength was reduced during the NARSUM examination, there was normal muscle strength during the physical medicine examination, 3 months before separation.  During both examinations, the CI had normal gait and only mild sensory deficits in the LLE.  Panel members concluded the evidence did not support the higher rating of 20% for moderate impairment of nerve function.  After due deliberation, considering all of 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 LLE radiculopathy. 

BOARD FINDINGS:  In the matter of the back condition and IAW VASRD §4.71, the panel recommends no change in the PEB adjudication.  In the matter of the LLE 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 20170501, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR20180006657 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.

Sincerely,					      
Enclosure