RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2017-04763
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20060202

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, UH-60 Helicopter Repairer, medically separated for “chronic low back pain secondary to degenerative disc disease [DDD] positive tenderness without neurologic deficit” with a disability rating of 10%.

CI CONTENTION:  Requested review of DDD and bilateral leg radiculopathy, and additional conditions (acid reflux and cardiomyopathy) not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB).  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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the 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 - 20051215	VARD - 20071107	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain…	5299-5242	10%	Cervical and Lumbar Spine DDD	5010	10%	20061216	
			Right Lower Extremity Radiculopathy	8527	0%	20061221	
			Left Leg Saphenous Nerve Neuropathy	8627	0%	20061221	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:

Chronic Low Back Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s low back condition began in March 2004 when a radio tower fell and clipped him in the lower back while deployed.  He was treated with pain medication which provided minimal relief.  In March 2005, he was involved in a motor vehicle accident resulting in multiple rib fractures, left arm weakness and low back pain.  An orthopedist diagnosed DDD, and a permanent L3 profile was issued.  A lumbar spine MRI in May 2005 showed an L5-S1 disc bulge with an associated angular tear, but no spinal stenosis or nerve root compromise.  Lumbar spine X-rays also performed in May 2005 were normal.  The CI was prescribed muscle relaxants, pain medication and referred to physical therapy (PT), which provided no relief.

The MEB PT examination on 21 November 2005, 3 months prior to separation, revealed back flexion to 62 degrees (normal 90) and combined range of motion (ROM) of 195 degrees (normal 240); painful motion was elicited.  During the MEB NARSUM examination the next day, the CI reported the inability to jump repeatedly, stoop, do overhead activities, or stretch.  He denied radicular pain or bladder/bowel dysfunction.  Physical examination showed a normal gait with painful heel-to-toe walk and lumbar spine tenderness.  Straight leg raise testing for radiculopathy was positive.  Extremity strength was 5/5, sensation testing was normal, and deep tendon reflexes were 2+ (normal).  Spinal ROM was not addressed.

At the 16 December 2006 VA Compensation and Pension (C&P) spine examination, 10 months after separation, the CI complained of daily back pain which radiated to both ankles and feet.  Physical examination showed a normal gait and posture, with no spinal tenderness or muscle spasm.  Thoracolumbar flexion was 90 degrees and combined ROM was 240 degrees; painful motion was not elicited.  During the C&P peripheral nerve examination the same day, the CI reported pain and tingling in both legs, with the left worse than the right.  Physical examination showed normal bilateral lower extremity sensory and reflex testing.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back condition 10%, analogously coded 5299-5242 (degenerative arthritis of the spine), citing spinal tenderness without neurologic deficits, and ROM limited by pain.  The VA also rated the low back condition 10%, but coded 5010 (arthritis, due to trauma), based on the C&P spine examination, citing X-ray evidence of DDD with full and normal ROM.  The VA also rated right lower extremity radiculopathy 0%, coded 8527 (internal saphenous nerve, paralysis), and left leg saphenous nerve neuropathy 0%, coded 8627 (neuritis), based on the C&P peripheral nerve examination, citing noncompensable examinations for both conditions.  Members agreed that a 10% rating, but no higher, was justified for limitation of flexion (greater than 60 degrees but not greater than 85 degrees, or combined thoracolumbar spine ROM greater than 120 degrees) as recorded on the MEB PT 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.  There was no documentation of intervertebral disc syndrome with incapacitating episodes that would provide for a higher rating under that formula.  Members also determined that while there was objective evidence of radiculopathy, there was no performance-based evidence from the record that this condition significantly interfered with satisfactory duty performance at separation.  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.

BOARD FINDINGS:  In the matter of the chronic low back pain and IAW VASRD §4.71, 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], XXXXXXXXXXXXXXXXXXXX

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Dear XXXXXXXXXXXXXXXXXXXX:

	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