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AF | PDBR | CY2012 | PD2012 01806
Original file (PD2012 01806.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX         CASE: PD1201806
BRANCH OF SERVICE: Army  BOARD DATE: 20140507
SEPARATION DATE: 20020103


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SGT/E-5 (92Y/Unit Supply Specialist) medically separated for his lumbar spine condition (L5-S1 radiculopathy with electromyogram [EMG] evidence of active denervation and mild abnormality of the right peroneal nerve). The radiculopathy could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty. His 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). The L5-S1 radiculopathy spine condition was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. No other conditions were submitted by the MEB. The Informal PEB adjudicated “L5-S1 radiculopathy with EMG evidence of active denervation and mild abnormality of the right peroneal nerve” as unfitting, rated 20%, citing criteria of the VA Schedule for Rating Disabilities (VASRD). The CI made no appeals and was medically separated.


CI CONTENTION: The CI elaborated no specific contention in his application.


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 spine/radiculopathy condition is addressed below; no additional conditions are within the DoDI 6040.44 defined purview of the Board. Any 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 IPEB – Dated 20011102
 VA - (Day of Separation)
Condition
 Code Rating Condition Code Rating Exam
L5-S1 Radiculopathy and DDD 8299-8720 20% Degenerative Disc Disease 5293 20% 20020103
Other x 0 (Not in Scope)
 Other x 1 20020103
Rating: 20%
 Rating: 20%
Derived from VA Rating Decision (VA RD ) dated 200 20225 ( most proximate to date of separation [ DOS ] ) .


ANALYSIS SUMMARY:

L5/S1 Radiculopathy. According to the narrative summary (NARSUM) and service treatment records, the CI developed problems with pain, numbness and muscle cramping of the right foot and calf (occasional hamstring in thigh) with exertion beginning in 1997 or 1998. Due to recurring symptoms the CI was evaluated by neurology on 27 October 2000. At that time, no back pain was present with the foot and leg symptoms. An EMG was positive for changes of a right L5/S1 radiculopathy. Magnetic resonance imaging (MRI) of the lumbar spine was performed on 21 January 2001, showed degenerative disc disease (DDD) at multiple levels with a small intervertebral disc herniation at L3-4 without impingement of nerve structures. There was disc bulging at L4-5 without herniation but narrowing of the bony spinal canal was noted. Degenerative changes were noted with “adequate” neuroforamen (i.e. adequate room for nerve roots without impingement or compression) at L5-S1. Neurology follow-up examination on 12 February 2001 recorded right lower leg muscle weakness and decreased right ankle reflex consistent with radiculopathy. The neurologist noted the absence of nerve root impingement on the MRI and commented that the radiculopathy was “almost certainly” due to a use dependent phenomenon associated with heavy physical exertion required in the Army. Orthopedic evaluation on 23 May 2001, noted the right leg and foot pain symptoms since 1997 that were “radicular in nature” which had increased since 2000. Some back pain (“20% axial”) symptoms were noted. On examination strength, reflexes and sensation were intact and provocative examination maneuvers for radiculopathy were negative. Lumbosacral range-of-motion (ROM) demonstrated “no significant limitation.” Gait was normal. The orthopedic surgeon reviewed the MRI and concluded it showed DDD that did not require surgery. The CI improved with non-surgical therapy and physical therapy; to the extent that a physical therapy note on 15 June 2001 noted the CI describing himself as being greater than 90% better noting no pain, no stiffness but having had fasciculations in his calf three to four times per day. The MEB NARSUM for the medical evaluation board completed on 20 June 2001, 6 months prior to separation, recorded complaint of constant right foot numbness and pain in the right foot interfering with walking, running and lifting more than 25 pounds. The CI reported spasms of the calf, hamstring and back. However, symptoms were much better and he was not interested in surgical treatment. The MEB NARSUM recorded the physical examination performed on 11 April 2001 was completely normal except for the following neurological findings: there was some decreased sensation in the first and second toes and a decreased right Achilles tendon reflex (at the ankle). Right lower extremity strength was recorded as normal (on SF-88 dated 11 April 2001). The back had “full range of motion” and the CI was able to achieve forward flexion until his fingertips were four inches from ground. The straight leg raise challenge test was negative for sciatic nerve irritation. The MEB NARSUM characterized the current status as chronic use dependent back pain and radiculopathy. The MEB NARSUM diagnosis was L5-S1 radiculopathy with active denervation (on EMG) due to degenerative disc and joint disease of the lumbar spine. The neurology evaluation performed on 13 July 2001 noted right leg pain and calf cramping with use. Back pain was noted to occur intermittently. A flare in April 2001 was noted associated with back pain that had improved with physical therapy. On examination, mild weakness of right lower leg muscles was noted. Gait was normal. Repeat EMG was positive for changes consistent with radiculopathy of right L5-S1. The CI indicated he continued to prefer non-surgical treatment. Due to recurring symptoms, the CI underwent a series of epidural steroid injections beginning in September 2001. By the time of a 12 December 2001 physical therapy appointment, the pain was resolved and he was able to tolerate non-impact exercise. The commander’s statement of 4 October 2001 noted his commendation for performance during command inspection while earning a 3.9 GPA taking 15 credit hours for a Masters of Philosophy. The commander stated that the CI had excelled in his duties as an engineer company supply sergeant and stated that the CI’s physical limitations had not significantly impacted his performance other than his inability to lift greater than 25 pounds. The VA Compensation and Pension spine specific examination performed on 3 January 2002, the day of separation, noted the history of low back pain with herniated disc and right foot and calf pain and weakness that was improved with non-surgical treatment. On examination, the CI had a normal gait and posture and had no muscle atrophy right calf or thigh. Right lower extremity reflexes were slightly reduced compared to the left but still graded in the normal range. Straight leg raise test described discomfort at 45 degrees of hip flexion on the right without detail. There was some tenderness to percussion of the lumbar spine. The ROM of the spine was 80 degrees of flexion (normal 90), 10 degrees of extension (normal 30). Right lateral flexion 30 degrees, left lateral flexion 30 degrees (normal 30).
The Board directs attention to its rating recommendation based on the above evidence. The PEB rated the right lumbar L5-S1 radiculopathy rated 20% for moderate severity using diagnostic code 8720 (sciatic nerve neuralgia). The VA adjudicated a 20% rating for DDD using the diagnostic code for intervertebral disc syndrome (5293; VASRD prior to September 2002 in effect at the time of the CI’s separation) citing moderate recurring attacks. In consideration of a rating using code 8720 under §4.124a for radiculopathy of a peripheral nerve, the board considered loss of strength, sensation, disturbance of gait, tremor and functional loss. The CI experienced periodic exacerbations, the last of which was at the end of the summer 2001, which improved with treatment. On 12 December 2001, the physical therapist recorded that his lower right leg pain had resolved with mild dorsal foot numbness and the CI was able to tolerate more than 30 minutes of non-impact cardio exercise. At the time of the VA C&P examination on the day of separation, the CI had no muscle atrophy with normal gait. The pain and numbness as of the date of separation would support a mild severity for 10% under the diagnostic code for sciatic nerve (8720). The commander’s statement documented success of the CI to accomplish the work required of his position under garrison conditions; thus it appeared that the limitation caused by his condition had minimal impacts on his ability to work in garrison and would justify a rating of 10% for mild but did not rise to the 20% of moderate or 40% of moderately severe under 8720 (sciatic nerve). The VA 20% rating under 5293 (intervertebral disc syndrome) took into account the combination of lumbar disc disease and recurrent nature of the CI’s radicular complaints. All members agreed that the PEB 20% rating was reasonable and also considered the overall disability picture evidenced in the treatment records. The Board considered whether there was a separately unfitting back pain condition meriting a separate unfit rating. The Board noted that while back pain was intermittently present, it was the right leg and foot symptoms that interfered with performance of duties rather than back pain itself. All members agreed that when the evidence of the treatment records was reviewed regarding back pain in isolation, there was not a preponderance of evidence to indicate that back pain alone was unfitting. Therefore, not subject to separate rating. 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 of a moderate severity ruling of 20% for the L5-S1 radiculopathy.


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. There were no other conditions within the Board’s scope of review for consideration. In the matter of the L5-S1 radiculopathy condition and IAW VASRD §4.124a, 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 20121009, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record


                 
XXXXXXXXXXXXXXXXXX
President
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 XXXXXXXXXXXXXXXXXX, AR20140018971 (PD201201806)

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

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