RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-04874
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050523

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6, Interrogator, medically separated for “chronic radiating low back pain [LBP]” with a disability rating of 10%.  

CI CONTENTION:  The VA gave him a higher rating.  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 - 20050216	VARD – 20051219	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Radiating LBP	5243	10%	S1-S2 Disc Herniation	5236	20%	20051102	
Radiculopathy	Not Unfitting	No VA Placement	
Left Knee Pain Status Post Arthroscopy	Not Unfitting 	Laxity of Anterior Ligament with Spontaneous Osteonecrosis, Left Knee	5260	10%	20051102	
Migraine Headaches	Not Unfitting	Chronic Migraines	8100	30%	20051102	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Chronic Radiating LBP.  According to the service treatment record and MEB narrative summary (NARSUM), the CI initially experienced LBP, with radiation down the left leg and foot, while deployed in May 2003.  A lumbar spine MRI on 14 July 2003 demonstrated anomalous development of six lumbarized vertebrae, moderate left paracentral disc protrusion at L5-S1, and a possible small protrusion at S1-S2.  The CI had an epidural steroid injection in August 2003 that completely resolved his back and leg pain until October 2003, when he aggravated it by lifting.   

Nonsteroidal anti-inflammatory drugs and muscle relaxants provided minimal relief and a physical medicine and rehabilitation examination on 28 January 2004 showed flexion to approximately 80 degrees (normal 90) with pain and tenderness over the paravertebral musculature.  An MRI on 23 March 2004 showed a transition lumbosacral segment and mild to moderate focal protrusion of the left posterolateral aspect of the L4-L5 intervertebral disc with disc material coming in contact with and mildly effacing the left anterolateral aspect of the thecal sac at that level.  A neurosurgeon’s impression on 25 October 2004 was left S1 radiculopathy with sensory abnormalities and faint signs of nerve root compression secondary to an L5-S1 herniated disc.  There was an indication for surgery, and a microdiscectomy with possible side effects was offered.  However, the CI reported declining surgery on 9 November 2004.  Examination on 29 December 2004 revealed fingers to the floor for flexion and all other motions 100% normal for his age.  Straight leg raising (to determine nerve root irritation) was negative.  Despite physical therapy, pain medication, and epidural steroidal injections, pain persisted.  

The 4 February 2005 MEB NARSUM examination, 3 months prior to separation, noted complaints of LBP with radiculopathy.  The physical examination incorporated the 31 January 2005 MEB examination findings, and showed that the CI moved slowly and deliberately, walked with a left-sided limp, and was hesitant to heel-toe walk.  After repetition, spinal range of motion (ROM) showed flexion of 90 degrees and combined ROM of 240 degrees (normal) (rotations were reported as 90 degrees to the left and 80 degrees to the right, which are measurements more likely found with cervical spine ROMs).  Straight leg testing was positive.  

At the 2 November 2005 VA Compensation and Pension (C&P) examination, less than 6 months after separation, the CI reported LBP.  Physical examination documented an altered gait favoring the left side, use of a cane for ambulation, and the ability to stand on heels and toes.  There was a flattening of the thoracic spine, but no pelvic tilt or paraspinal tenderness or tension.  Thoracolumbar ROM showed flexion of 90 degrees and combined ROM of 240 degrees.  Pain was noted at the extremes of all ROM measurements with an additional limitation of 20 degrees of flexion due to fatigue and pain following repetitive motion.  Motor strength was normal as was sensation.  Spine X-rays dated 3 November 2005 showed six non-rib-bearing lumbar-type vertebrae with slight levoconvex curvature of the lumbar spine and no significant degenerative changes of the thoracic spine; sacroiliac joints 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 muscle tenderness.  The VA rated the low back condition 20%, coded 5236 (sacroiliac injury and weakness), based on the C&P examination, citing flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or combined ROM not greater than 120 degrees.  Although there was insufficient limitation of motion to support a 10% rating, the panel agreed a 10% rating was justified for the presence of tenderness, although it was noted 16 months prior to separation and 6 months after 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.  There was no documentation of intervertebral disc syndrome with incapacitating episodes which would provide for a higher rating under that formula.  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 chronic radiating LBP.  

Contended PEB Condition:  Radiculopathy.  The panel’s main charge is to assess the fairness of the PEB determination that the contended condition was not unfitting.  The radiculopathy was profiled, but was not explicitly mentioned in the commander’s statement, and did not fail retention standards.  In May 2003, the CI reported shooting pain from the lower back down to the back of the left lower leg into the foot.  An initial steroid injection gave immediate pain relief, and another injection in January 2004 provided complete resolution of the radiculopathy.  Nevertheless, at a neurosurgical evaluation on 25 October 2004, an S1 radiculopathy was documented based on MRI findings.  

The panel considered whether an additional rating could be recommended under a peripheral nerve code.  Firm panel precedence requires a functional impairment linked to fitness to support a recommendation for addition of a peripheral nerve rating to Service disability in spine conditions.  Although the pain component of the neuropathy is appropriately subsumed in the spine rating IAW VASRD §4.71, which states that “rating is performed with or without symptoms such as pain (whether or not it radiates), stiffness, or aching in the area of the spine affected by residuals of injury or disease,” there was no sensory component with any significant functional implications and no motor weakness specifically associated with the S1 radiculopathy.  Therefore, a radiculopathy could not be recommended for additional disability rating.  Also there was no performance-based evidence from the record that the radiculopathy 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 the contended radiculopathy condition, so no additional disability rating is recommended.  

Contended PEB Conditions:  Left Knee Pain Status Post Arthroscopy and Migraine Headaches.  The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting.  Neither of the conditions was profiled or implicated in the commander’s statement, and did not fail retention standards.  There was no performance-based evidence from the record that 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 left knee pain arthroscopy and migraine headaches contended conditions, so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the chronic radiating low back pain and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended radiculopathy, left knee pain status post arthroscopy and migraine headache conditions, 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.  

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Dear XXXXXXXXXX:

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