RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2013-01399
BRANCH OF SERVICE:  Army	BOARD DATE:  20141217
Separation Date:  20050303

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated National Guard E-5 (Helicopter Repairer) medically separated for a back condition.  The back condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS).  The profile allowed for an alternate aerobic event to satisfy physical fitness standards.  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  “Left lower extremity radiculopathy,” “left lower extremity paresthesia, moderate,” and “L5-S1 herniated nucleus pulposus [HNP] (of left paracentral), moderate” were forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The Informal PEB adjudicated chronic back pain with left lower extremity (LLE) symptoms with limitations in range-of-motion (ROM) by pain as unfit and existed prior to service (EPTS).  The CI appealed to the Formal PEB which adjudicated the condition as unfitting, rated 10%; and the CI was medically separated.

CI CONTENTION:  “VA found the rating to be 30%.”

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e.(2).  It is limited to those conditions determined by the PEB to be unfitting for continued military service and those conditions identified but not determined to be unfitting by the PEB when specifically requested by the CI.  The rating for the unfitting back condition is addressed below; and, no additional conditions are within the DoDI 6040.44 defined purview of the Board.  Any other conditions or contention not requested in this application, or otherwise outside the Board’s defined scope of review, remain eligible for future consideration by the Board for Correction of Military Records.

RATING COMPARISON:

Service FPEB – Dated 20050131 | VA - (3.5 Months Post-Separation)
Condition | Code | Rating | Condition | Code | Rating | Exam
Chronic Back Pain with LLE Symptoms | 5243 | 10% | LLE Radiculopathy with Paresthesia’s, Herniated Disc, Lumbar Spine | 8620 | 20% | 20050618
| | | Herniated Disc, Lumbar Spine | 5243 | 10% | 20050618
Other x 0 | Other x 0
Rating:  10% | Combined Rating:  30%
Derived from VA Rating Decision (VARD) dated 20050825 (most proximate to date of separation [DOS])

ANALYSIS SUMMARY:  IAW DoDI 6040.44, the Board’s authority is limited to making recommendations on correcting disability determinations.  The Board’s role is thus confined to the review of medical records and all evidence at hand to assess the fairness of PEB rating determinations, compared to VA Schedule for Rating Disabilities (VASRD) standards, based on ratable severity at the time of separation.

Chronic Back Pain with Left Lower Extremity Symptoms.  The CI developed back pain which radiated down his left leg in July 2003 during a commander’s run.  He sought care with a civilian specialist who administered a series of three epidural steroid injections which resolved the pain.  The CI continued to have left lower extremity radicular pain and was seen by Primary Care for reevaluation.  The physical exams consistently demonstrated normal bilateral strength, reflexes and sensation; however, there was a positive straight leg raise (SLR) on the left.  A lumbar spine magnetic resonance imaging (MRI) demonstrated a large left posterior disc herniation at L5-S1, with spinal, lateral recess and neural foraminal stenosis.  The CI was evaluated by Orthopedics and noted to have no weakness in the bilateral lower extremities, however there continued to be a finding of a positive left straight leg raise.  The examiner diagnosed L5-S1 HNP.  The CI presented to Primary Care for a recurrence of back pain with decreased ROM secondary to pain which radiated to his left leg.  There were physical exam findings of lower back tenderness, decreased ROM, a positive Romberg test and decreased ROM in the left leg.  The examiner placed the CI on Quarters for 48 hours with specific restrictions of no flying, marching, formation or physical therapy for 48 hours.  A repeat lumbar spine MRI demonstrated a moderately large left paracentral disc protrusion which caused moderate spinal canal narrowing on the left with mild left sided neural foraminal narrowing.  The electromyelogram (EMG) demonstrated a normal test with no findings consistent with radiculopathy.  The MEB narrative summary (NARSUM) exam approximately 9 months prior to separation documented that the CI’s back pain with a left S1 radicular symptoms was refractory to conservative treatment.  There was no physical exam done at that time.  The CI was given a permanent P3/L3 profile for left lumbar HNP L5-S1 with radiculopathy.  The commander’s statement indicated the CI’s medical condition rendered him unable to perform his MOS duties.  The MEB NARSUM addendum exam approximately 6 months prior to separation documented the CI had chronic lower back pain with radiating pain to the left lower activity.  The MEB NARSUM addendum physical exam findings are summarized in the chart below.  The VA Compensation and Pension (C&P) exam approximately 4 months after separation documented worsening low back throbbing, achy pain that radiated to the back of the CI’s left buttocks, leg and knee.  The VA C&P physical exam findings are summarized below.

There were three goniometric ROM evaluations in evidence, with documentation of additional ratable criteria, which the Board weighed in arriving at its rating recommendation; as summarized in the chart below.

Thoracolumbar ROM (Degrees) | MEB ~5.5 Mos. Pre-Sep | PT ~3 Mos. Pre-Sep | VA C&P ~3.5 Mos. Post-Sep
Flexion (90 Normal) | 90 | 65 | 90
Combined (240) | 220 | 190 | 240
Comment | Pos. painful motion & antalgic gait; Normal strength & reflexes; Slight decreased sensation left lateral thigh; Pos. straight leg raise (SLR) on left, neg. on right | Pos. painful motion | Pos. painful motion & antalgic gait; Pos. SLR on left; Normal strength & reflexes
§4.71a Rating | 10% (FPEB 10%) | 10% | 10% (VA 10%)

The Board directed attention to its rating recommendation based on the above evidence.  The PEB coded the chronic back pain with LLE symptoms condition 5243 (intervertebral disc syndrome), rated 10%.  The VA also used code 5243 for the LLE radiculopathy with paresthesia’s associated with herniated disc, lumbar spine condition, rated 10%.  The VA also rated the left sided radicular symptoms at 20% using code 8620 (neuritis of the sciatic nerve).  Board precedent is for a functional impairment tied to fitness as the requirement to support a recommendation for addition of a peripheral nerve rating at separation.  The pain component of a radiculopathy is subsumed under the general spine rating as specified in §4.71a.  The sensory component in this case has no functional implications.  There was no motor impairment documented and an EMG performed was normal.  Since no evidence of functional impairment exists in this case, the Board cannot support a recommendation for additional rating based on peripheral nerve impairment.  All exams present for review documented thoracolumbar ROM measurements were consistent with the 10% rating.  The Board reviewed the evidence in consideration of rating the intervertebral disc syndrome based on incapacitating episodes.  The evidence documented the CI had been placed on quarters for greater than one week but less than 2 weeks in the year prior to separation.  That also corresponds to a 10% rating based on incapacitating episodes.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the chronic back pain with LLE symptoms.

BOARD FINDINGS:  IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB will not be considered by the Board to the extent they were inconsistent with the VASRD in effect at the time of the adjudication.  The Board did not surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD were exercised.  In the matter of the chronic back pain with left lower extremity symptoms and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION:  The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20130910, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

XXXXXXXXXXXXXXX
President
DoD Physical Disability Board of Review

SAMR-RB									

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXX, AR20150007598 (PD201301399)

I have reviewed the enclosed Department of Defense Physical Disability Board of Review (DoD PDBR) recommendation and record of proceedings pertaining to the subject individual.  Under the authority of Title 10, United States Code, section 1554a,   I accept the Board’s recommendation and hereby deny the individual’s application.  This decision is final.  The individual concerned, counsel (if any), and any Members of Congress who have shown interest in this application have been notified of this decision by mail.

 BY ORDER OF THE SECRETARY OF THE ARMY:

Encl						     XXXXXXXXXXXXXXX
						     Deputy Assistant Secretary of the Army
						          (Review Boards)
						         
CF: 
(  ) DoD PDBR
(  ) DVA

PD-2013-01399