RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX 	CASE:  PD-2017-05182
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20081012

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Indirect Fire Infantryman, medically separated for “right L5-S1 herniated disk with significant lateral stenosis” and “right S1 radiculopathy” each rated 10%, with a combined disability rating of 20%.   

CI CONTENTION:  No specific contention was made.  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 – 20080626	VARD - 20081031	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right L5-S1 Herniated Disc with Significant Lateral Stenosis	5243	10%	Lumbar Degenerative Disc Disease and Degenerative Joint Disease	5237	10%	20080730	
Right S1 Radiculopathy	8620	10%	Right Sided Sciatica	8520	10%	20080730	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Right L5-S1 Herniated Disc.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s low back pain (LBP) began in late 2003 when he was thrown from his military vehicle after it was struck by an RPG.  Despite years of conservative treatment, his back pain was intermittently exacerbated by various activities.  Eventually, he developed painful tingling extending down the back of the right leg into the right foot.  On 13 September 2007, an MRI of the lumbar spine revealed a right-sided L5-S1 herniated disc.  Electro-diagnostic studies performed on 13 November 2007 identified a right-sided S1 radiculopathy.   

During the 5 March 2008 MEB examination (recorded on DD Forms 2807-1 and 2808), 7 months prior to separation, the CI reported constant LBP associated with tingling and numbness extending down the right leg and foot.  The physical examination (PE) revealed tenderness and spasms about the lumbar spine and the right-sided sacral-iliac (SI) joint.  Range of motion (ROM) of the low back was decreased and painful.  His gait and the strength of the lower extremities were normal.  The 29 April 2008 MEB NARSUM examination, 5 months prior to separation, noted similar complaints as above.  Additionally, he endorsed the inability to run, ruck march or wear his IBA due to significant back pain.  His PE remained unchanged except for the absence of tenderness over the right SI joint.    Thoracolumbar ROM measurements performed by physical therapy on 8 May 2008, 5 months prior to separation, revealed painful motion noting flexion to 65 degrees (normal 90) and combined ROM of 185 degrees (normal 240) after repetition.  

At the 30 July 2008 VA Compensation and Pension (C&P) examination, 2 months prior to separation, the CI reported constant LBP extending into the right leg associated with numbness of his right foot.  He endorsed that the foot numbness occurred twice a day following prolonged standing with a duration of 5 minutes per each occurrence.  The same symptom was “eased” with rest and sitting.  Symptom aggravation included maneuvering stairs, bending, and/ or lifting.  The CI’s activities of daily living were not adversely affected and he maintained the ability to drive.  The PE revealed normal forward flexion and bilateral lateral flexion with a combined ROM of 210 degrees.  There was no change in motion upon repetition.  Painful motion was present as well as tenderness about the right SI joint.       

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 forward flexion of 65 degrees.  The VA also rated the back condition 10%, coded 5237 (lumbar spine strain), based on the C&P examination, citing combined ROM of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees.  The panel agreed that a 10% rating, but no higher, was justified for limitation of motion as reported on the most probative VA examination.  Near the time of separation, there was no documented evidence of paraspinal 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.  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. 

S1 Radiculopathy.  The MEB examination (recorded on DD Form 2808), summarized the CI’s condition of back pain extending into the right buttock with altered sensation in the right leg and numbness in the right foot.  Two months later at the MEB NARSUM examination, the CI complained of tingling down his right leg and into his toes after prolonged sitting.  The PE revealed a normal gait and normal peripheral reflexes.  Peripheral motor control, sensation and strength parameters were normal.  

At the VA examination, the CI reported continued right-sided radicular symptoms of pain and altered sensation.  The PE revealed no evidence of muscular atrophy and thus normal strength of the lower extremities.  All peripheral reflexes were also normal.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right S1 radiculopathy condition 10%, coded 8620 (neuritis; sciatic nerve), citing mild incomplete paralysis.  The VA also rated the right sided sciatica condition 10%, coded 8520 (incomplete paralysis of the sciatic nerve), based on the C&P examination, citing incomplete paralysis below the knee which was mild.  Panel members first agreed that a VASRD neurologic coding approach was appropriate in this case given the subjective complaints being consistent with normal nerve distribution of the CI’s peripheral symptoms.  Members further agreed however, that absent evidence of motor weakness or reflexes of the lower extremities, a rating no greater than the PEB’s “mild” (10%) impairment was supported.  After due deliberation, considering all the evidence and mindful of VASRD §4.3, the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the S1 radiculopathy condition.  

BOARD FINDINGS:  In the matter of the right L5-S1 herniated disc condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the S1 radiculopathy 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.  

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.