RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-04647
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20050621

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Tactical Aircraft Maintenance Craftsman, medically separated for “low back pain [LBP] with residual left leg S1 sensory symptoms” and “meralgia parenthetical,” rated 10% and 0%, respectively, with a combined disability rating of 10%.   

CI CONTENTION:  “Upon facing medical separation I was an E5 with six years of service, due to medical profile I was non promotable and unqualified for future reenlistment which would have been my third enlistment.  I was ineligible for deployment due to the medical condition and was deemed 10% and given severance pay.  Due to the permanent nature of the condition and the necessary ongoing treatment and pain management necessary, I wish to request a review of the evaluation and consideration be given to the life long nature of this ailing condition which would warrant a 30% percent rating and medical retirement from the United States Air Force.  Requesting PDBR review under Wounded Warrior Act.  Request to assign a rating which would result in re-characterization of separation to medical retirement retroactive to original date of separation. 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 - 20050504	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
LBP with Residual Left Leg S1 Sensory Symptoms	5243	10%	No VA Examination Proximate to 
Separation in Evidence	
Meralgia Paresthetica	8729	0%		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

LBP with Residual Left Leg S1 Sensory Symptoms.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI underwent back surgery with L5-S1 microdiscectomy in October 2002, 16 months prior to the NARSUM, for herniated disc with left S1 radiculopathy.  Post-operative imaging showed no evidence of residual disc problem but some scarring was present around the disc.  Following surgery the CI had persistent numbness in the lateral aspect of his foot and occasional twinges in the S1 distribution.  In the year before the NARSUM, the CI developed increased LBP.  Repeat MRIs in May 2004 and 2 February 2005 showed a small residual disc bulge or scarring, slightly displacing the SI nerve root, without significant change.  The CI was not interested in further surgery and no further surgery was recommended at the time.  

The 15 February 2005 MEB NARSUM examination, 4 months prior to separation, noted complaints of LBP and some left leg pain.  Physical examination showed a normal gait and station.  Muscle strength and reflexes were normal throughout, except the left Achilles reflex was absent.  There was decreased sensation in the left S1 distribution, sensation was otherwise intact from C2 to S2 bilaterally.  There was no significant tenderness of the back.  The CI had mild discomfort with flexion, but could reach down to fingers within 3 inches of the floor (normal) and extension was approximately 10 degrees (normal 30).  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 low back condition 10%, coded 5243 (intervertebral disc syndrome), citing DoD and VASRD guidelines.  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 examination.  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.  Although the CI had mild residual intervertebral disc syndrome, there was no evidence of incapacitating episodes requiring physician-prescribed bed rest to warrant consideration of rating under the alternate VASRD formula for that condition.  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.  

Meralgia Paresthestica.  According to the STR and MEB NARSUM, the CI’s meralgia paresthetica condition began in approximately 2004.  The CI reported pain and numbness in his left lower extremity.  The CI had a history of discectomy at L5-S1 for a left S1 radiculopathy in 2002 as discussed above.  Following the surgery, the CI’s left lower extremity pain improved, but he continued with numbness in the S1 distribution.  At a neurological examination on 11 February 2005, the CI reported lower back pain and numbness and a burning sensation in the left lateral thigh.  He denied weakness or other neurological symptoms.  Physical examination showed a normal gait, with normal heel and toe walk.  Muscle strength was normal throughout, without muscle atrophy or fasciculations.  Sensation was intact except over the left lateral thigh in the lateral femoral cutaneous nerve distribution.  Reflexes were normal except for a decrease in the left knee and ankle.  The neurologist diagnosed meralgia paresthetica (a compression neuropathy of the lateral femoral cutaneous [LFC] nerve, often under the inguinal ligament, due to anything that increases pressure in the area, such as clothing, belts, or scar tissue) and thought the CI’s decreased left reflexes were old and related to his past surgical history.  There was no evidence of a femoral neuropathy or lumbar plexopathy.  The neurologist recommended the CI change his sleeping position and avoid wearing his seat belt low and the condition could resolve with avoiding compression.  

The MEB NARSUM examination noted complaints of left leg pain.  Physical examination showed motor strength was full throughout.  Sensation was intact from C2 to S2, except for decreased sensation in the S1 distribution.  Reflexes were normal except for the absent left ankle reflex.  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 meralgia paresthetica condition 0%, analogously coded 8729 (external cutaneous nerve of thigh neuralgia, also called the LFC nerve of the thigh).A 0% rating coded 8729 for mild to moderate incomplete paralysis was supported based on the neurology and MEB NARSUM examinations proximate to separation.  The neurologist noted numbness in the distribution of the LFC nerve, but this was not noted in the MEB NARSUM examination, 4 days later, which argued against recommending a 10% rating for a severe incomplete or complete nerve paralysis.  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 meralgia paresthetica condition.  

BOARD FINDINGS:  In the matter of the low back pain with residual left leg S1 sensory symptoms and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the meralgia paresthetica 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:

	

XXXXXXXXXX
XXXXXXXXXX
XXXXXXXXXX

Dear XXXXXXXXXX:

	Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-04647.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate.  Accordingly, the Board recommended no rating modification or re-characterization of your separation.

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that modification of your disability rating or characterization of your separation is not warranted.  Accordingly, I accept the recommendation that your application be denied.