RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXX	CASE:  PD-2017-06044
BRANCH OF SERVICE:  AIR FORCE 	SEPARATION DATE:  20070418

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a Reserve O3, Financial Management Officer, medically separated for “chronic low back pain” and “decreased tactile sensation and proprioception left leg,” rated 10% and 10%, respectively, with a combined disability rating of 20%.  

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 - 20070221	VARD - 20080117	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5243	10%	DDD, Lumbar Spine	5243	10%	20071204	
Decreased Tactile Sensation and Proprioception Left Leg	8620	10%	Sciatica Associated with DDD, Lumbar Spine	8521	NSC	20071204	
Adjustment Disorder 	Cat III	Adjustment Disorder 	9440	10%	20070705	
COMBINED RATING:  19%	COMBINED RATING OF ALL VA CONDITIONS:  40% 	

ANALYSIS SUMMARY:  

Chronic Low Back Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI underwent back surgery with laminectomy in July 2006 for nerve root compression from herniated disk at L5-S1.  She improved enough to return to a 4-hour duty day in December 2006.  The 9 January 2007 MEB NARSUM examination, 3 months prior to separation, noted complaints of mild right lower back pain with dull ache at times and no radiation into the right lower extremity.  Physical examination showed normal posture and normal appearing lumbosacral spine, but there was tenderness, muscle spasms and pain was elicited by motion.  Straight leg raise testing was positive in the left lower extremity, and sensation was decreased.  Thoracolumbar range of motion (ROM) testing documented flexion to 75 degrees (normal 90), and extension to 5 degrees (normal 30). 

At the 6 July 2007 VA Compensation and Pension (C&P) examination, 3 months after separation, the CI reported daily mechanical low back pain at an intensity of 10/10.  The CI stated she was unable to perform the activities of daily living without assistance from family members, and was bed or chair ridden most of the day.  There was no report of incapacitating episodes requiring prescribed bedrest.  Physical examination showed decreased lumbar lordosis, a tender surgical scar, and tenderness throughout the lumbosacral spine and musculature.  Sensation was intact for bilateral lower extremities.  However, motor strength of the left foot was reduced to 4/5, but the examiner noted, “no true left foot drop present.”  The ROM study showed flexion of 75 degrees and extension of 0 degrees.  There was painful motion throughout movement, but no additional limitation due to weakness, fatigability or loss of coordination during or following three repetitions of ROM.

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).  The VA also rated the back condition 10%, coded 5243, based on the C&P examination, citing limitation of forward flexion.  The panel agreed that a 10% rating, but no higher, was justified for combined ROM (greater than 120 degrees but not greater than 235 degrees), as reported on the MEB examination proximate to separation.  There was no muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour to warrant a higher 20% rating.  There was no evidence of intervertebral disc syndrome which resulted in incapacitating episodes requiring physician-prescribed bed rest to warrant a higher 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 back condition.  

Decreased Tactile Sensation and Proprioception Left Leg.  According to the STR and MEB NARSUM, the CI’s left leg condition began in April 2006 after experiencing weakness and foot drop on the left with persistent numbness in the posterior left leg.  In June 2006 electrodiagnostic studies were normal and there was no electrophysiological evidence of a left lower extremity radiculopathy.  During the MEB NARSUM examination, the CI reported return of mild sensation on the posterior heel, but deep pressure on the numb areas of the foot caused deep aching pain.  Physical examination revealed localized muscle atrophy of the left calf, noted to have lessened with increased activity, and relatively normal motor strength at the left ankle and foot.  There was decreased sensation of the left foot and posterior aspect of the left thigh, and decreased proprioception and position sensation of the left leg and foot.  Left ankle ROM testing showed 5 degrees of dorsiflexion (normal 20) and 38 degrees of plantar flexion (normal 45).

At the C&P examination the CI complained of right leg paresthesias and dysesthesias in a stocking distribution.  There were no documented complaints of the left leg.  The physical examination showed an antalgic gait favoring the left leg and the CI was using a cane and a left in-shoe ankle-foot orthosis.  Sensation was intact to light touch throughout the bilateral lower extremities and motor strength was reduced to 4/5, but no true left foot drop was present.  Muscle atrophy was not documented.  The left ankle reflex was absent but the remainder of reflexes were all normal.  The ROM study showed left plantar flexion of 30 degrees (pre and post-repetitive) and there was 8 degrees of dorsiflexion, which improved to 10 degrees post-repetitive motion.  There was no apparent pain, weakness, fatigability or loss of coordination during or following three repetitions of ROM.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the left leg condition 10%, coded 8620 (neuritis).  The VA did not rate the left leg condition, but rather found it not service connected, coded 8521 (paralysis of), based on the C&P examination, citing lack of available medical evidence.  A 10% rating is the highest rating achievable under the 8620 code.  Panel members considered a higher rating under code 8520, but noted the normal electrodiagnostic study, the NARSUM examiner’s statement that the left leg weakness was improving and the VA C&P examination that showed mild reduction in motor strength of the left foot, intact sensation to light touch and absent left ankle jerk reflex with normal reflexes in the remainder of the left lower extremity.  Foot drop was not present at the time of the VA C&P examination.  Panel members agreed, the higher rating of 20% under code 8520 for moderate incomplete paralysis was not warranted.  The panel also considered rating under code 8523 (paralysis of dorsal flexion of the foot) but was unable to find a path to a higher rating since the condition did not meet the criteria for severe incomplete paralysis.  The C&P examiner noted dorsiflexion improved with repetition, and there was no apparent pain, weakness, fatigability or loss of coordination during or following three repetitions of ROM.  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 left leg condition.  

Contended PEB Condition:  Adjustment Disorder.  IAW DoDI 1332.38, enclosure 5, adjustment disorder is a condition not constituting a physical disability.  After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the back condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the left lower extremity condition and IAW VASRD §4.124a, the panel recommends no change in the PEB adjudication.  In the matter of the contended adjustment disorder, the panel agrees that it cannot recommend it for additional disability rating.  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.

SAF/MRB

Dear XXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-06044.

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 re-characterization or modification 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 re-characterization of your separation is not warranted.  Accordingly, I accept their recommendation that your application be denied.