RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2017-04765
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060731

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6, Avenger Crewmember, medically separated for “chronic radiating lower back pain” 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 - 20060607	VARD - 20061116	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Radiating Lower Back Pain	5243	10%	Degenerative Disc Disease, L3-4, L4-5, and L5-S1, Status Post Hemilaminectomy with Disc Removal L3-S1	5243	10%	20060922	
Cold Sensitivity of Hands	Not Unfitting	Chronic Cold Injury, Right Upper Extremity	7122	10%	20060922	
		Chronic Cold Injury, Left Upper Extremity	7122	10%	20060922	
Bilateral Carpal Tunnel Syndrome	Not Unfitting	Carpal Tunnel Syndrome, Left Upper Extremity	8515	0%	20060922	
		Carpal Tunnel Syndrome, Right Upper Extremity	8515	0%	20060922	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Chronic Radiating Lower Back Pain (LBP).  According to the service treatment record and MEB narrative summary (NARSUM), the CI underwent back surgery on 14 June 2005, which included: a hemilaminectomy at L4 and L5; partial hemilaminectomy at S1; partial facetectomy at L4-5 and L5-S1; foraminotomy of L4, L5, and S1; and excision of herniated disks at L4-5 and L5-S1, all on the left side.  The surgery relieved the intense pain in the left leg all the way to the heel, but he continued to experience LBP that interfered with completing military duty requirements.  

During the 12 September 2005 MEB examination (recorded on DD Forms 2807-1 and 2808), 3 months post-surgery and 11 months prior to separation, the CI reported LBP and left leg pain that prevented him from staying in any one position for any extended period of time, and interrupted his sleep.  Thoracolumbar range of motion (ROM) measurements taken by the physical therapy (PT) clinic on 8 December 2005, showed flexion to 80 degrees (normal 90) and combined ROM of 220 (normal 240), with painful motion.  The examiner recorded tenderness over the incision site, and 5/5 strength bilaterally in the lower extremities.  

The 27 December 2005 MEB NARSUM examination, 7 months before separation, noted CI complaints of constant LBP aggravated by any activity and most intense in the morning after getting up.  He still had pain radiating down to the left knee when his back was aggravated.  The examiner reported minimal evidence of back pain while walking, but noted pain when he reached to take off his shoes or socks or pick up objects off the floor.  Physical examination showed no tenderness and pain-free ROM with flexion to 25 degrees, extension to 5 degrees, and lateral bending that was “very limited.”  Patellar and Achilles reflexes were 2+ bilaterally, normal toe and foot strength and sensation intact.  Straight leg raises bilaterally caused LBP that radiated into the hips.  A 26 April 2006 NARSUM addendum, 3 months before separation, confirmed all the evidence in the NARSUM remained current and accurate.  Back ROM measurements, recorded at the PT clinic on 6 June 2006, 2 months before separation, showed flexion to 80 degrees and combined ROM of 205 degrees, with painful motion.  The examiner noted tenderness, but no spasm or antalgic gait.  

At the 22 September 2006 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported LBP aggravated by lifting, twisting, and turning.  Physical examination showed forward flexion to 60 degrees, but no further due to pain; extension was not documented (although the VA rating decision indicated extension recorded at 20 degrees), but the examiner reported lateral flexion to 30 degrees bilaterally and rotation to 20 degrees bilaterally, with pain at endpoints.  The examiner also stated, “It should be noted though that the veteran had no difficulty sitting in the chair with his feet flat on the ground, bending over and putting his shoes on.  There was no subjective or objective evidence of pain when he did that, when he did forward flexion he said his back hurt, he did not grunt or grimace at that time.  When showing how his knees would bother him at times with kneeling, he would get down and could bend over and tie his shoes or bend and put his hands to the floor.  When sitting on the examination table to examine his lower extremities, when we did sensation which was intact to light touch, pinprick and vibratory sense of the lower extremities, he could raise his legs to 80 degrees multiple times without evidence of objective signs of pain, nor did he state that there was pain at that time.”  Further examination showed minimal tenderness to the lower lumbar area and no spasm.  

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 (IVDS)), citing tenderness.  The VA also rated the back condition 10%, coded 5243, based on the C&P examination, citing limited motion.  In assigning probative value to these somewhat conflicting examinations, members noted the ROM values reported by the PT examiner on 8 December 2005 and 6 June 2006 were nearly identical and showed stability over time.  The NARSUM examiner reported severe limitation of ROM that was without pain, and so could not be attributed to a flare of symptoms.  The panel agreed the PT evaluations were more consistent with the preponderance of evidence in the STR and more reflective of the degree of disability at time of separation, and adjudged 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).  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 IVDS with incapacitating episodes which would provide for a higher rating under that formula.  

The panel noted the PEB explicitly stated “there are no separately unfitting clinical signs of radiculopathy” in the disability description, but the CI contended this condition, and it is therefore in the panel’s scope of review.  When considering if an additional disability rating was justified for peripheral nerve impairment due to radiculopathy, members noted symptoms of radiating pain documented in the treatment records as well as radicular pain treated with surgery.  However, examinations indicated normal strength, reflexes and gait, and that sensory changes did not affect job performance.  The presence of functional impairment with a direct impact on fitness is the key determinant in the panel’s decision to recommend any condition for rating as additionally unfitting.  While the CI may have suffered additional pain from the nerve involvement, this is subsumed under the general spine rating criteria, which specifically states “with or without symptoms such as pain (whether or not it radiates).”  Therefore, the critical decision is whether or not there was a significant motor weakness which would impact military occupation-specific activities.  There was no evidence that motor weakness existed to any degree that could be described as functionally impairing.  The panel therefore concluded an additional disability 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 back condition.  

Contended PEB Conditions:  Cold Sensitivity of Hands and Bilateral Carpal Tunnel Syndrome.  The panel’s main charge is to assess the fairness of the PEB determination the contended conditions were not unfitting.  Neither of the conditions were profiled or implicated in the commander’s statement.  The NARSUM addendum specifically stated the carpal tunnel syndrome had resolved after the carpal tunnel releases completed on each of the hands.  There was no performance-based evidence from the record either of the 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 either of the contended conditions, so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the chronic radiating lower back pain and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended cold sensitivity of hands and bilateral carpal tunnel syndrome, 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:

 [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