RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2013-01375
BRANCH OF SERVICE:  NAVY	BOARD DATE:  20150116
SEPARATION DATE:  20040802

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5 (Shore Base Airport and Aircraft Firefighter) medically separated for a lumbar spine condition.  The condition could not be adequately rehabilitated to meet the physical requirements of his Rating or satisfy physical fitness standards.  He was placed on limited duty (LIMDU) for L4/5 degenerative disk disease and referred for a Medical Evaluation Board (MEB).  The back condition, characterized as “Lumbar Spondylosis with Degenerative Disk Disease” was forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated the condition as unfitting, rated 10%.  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 when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting.  Any conditions outside the Board’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/Naval Records.  Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation.  The Board 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, operating under a different set of laws.  The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.

RATING COMPARISON:

Service IPEB – Dated 20040623	VA - (1 Month Pre-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Lumbar Spondylosis with Degenerative Disks	5243	10%	Degenerative Disk Disease of the Lumbar Spine	5243-5003	10%	20040715	
Other x 0  	Other x 1	
Rating:  10%	Combined:  20%	
Derived from VA Rating Decision (VARD) dated 20040909 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Lumbar Spondylosis with Degenerative Disks.  Treatment records note that CI hurt his back while lifting a basketball goal in the hanger deck to mount it.  He presented to Orthopedics Clinic May 1999, reporting sharp and burning pain that went across the back and buttock in a bilateral and equal distribution.  He rated his pain 4/10.  Magnetic resonance imaging (MRI) of the spine from April 1999 showed an old L1-2 compression fracture resultant kyphosis and degenerative changes at that level as well as L4-5 with a question of a posterior spot that could be a tear.  He was placed on 6-month LIMDU and referred to physical therapy with a trial of an anti-inflammatory medication.  In July 2000, he presented to Orthopedics Clinic reporting a recurrence of low back pain (LBP) consequent  with his duty on the flight deck, lifting heavy objects and doing prolonged standing and bending work.  Repeat MRI showed a large central disc bulge at L4-5 with no nerve root involvement.  He was placed on LIMDU for 8 months and physical therapy and anti-inflammatory medication were recommended.  Treatment records were silent until he presented to the emergency room on September, 2003 with back pain radiating down the legs.  He could not sit or stand for long periods.  Lumbar strain and right sciatica were diagnosed.   Three months later he went to Pain clinic with chronic mid LBP, exacerbated by Hurricane clean up and rated between 3 to 6/10.

At the narrative summary dated 4 March 2004, the CI reported he had pain 60% in his back that radiated to both anterior thighs (left greater than right).  On physical exam, he stood listed to the left and had mild spasm in his paraspinal muscles.  Forward flexion was limited secondary to pain.  Deep tendon reflexes and sensory exam were normal.  Straight leg tests went to 75 degrees bilaterally.  “He was able to walk on his toes and tiptoes without difficulty.”  MRI showed a herniated disc with mild mass effect at the left S1 nerve root.  He had two steroid injections in the back without relief.  The non-medical assessment, dated June 2004, indicated the CI’s back problems precluded him from being able to perform his duties. He had not missed any work as scheduled.

At the VA Compensation and Pension exam dated 15 July 2004 performed 3 weeks prior to separation; the CI reported he had back pain discomfort with bending, twisting, heavy lifting, and standing and sitting for long periods.  He denied lower extremity pains, bowel or bladder dysfunction, decreased muscle strength, or gait disturbance.  Pain was constant and rated 2-3/10.  Physical exam revealed a normal posture and gait.  Exam of the lumbar spine showed no appreciable radiating pain on movement, muscle spasm or tenderness.  Straight leg raise was negative bilaterally and there were no signs of radiculopathy.  Range-of-motion revealed flexion at 90 degrees (normal 90), extension at 30 degrees (normal 30), right and left lateral flexion at 30 degree (normal 30), and right and left rotation at 30 degrees (normal 30), without ankylosing or pain.  There was no limitation by fatigue, weakness, lack of endurance, or incoordination.  There was no intervertebral disc syndrome.  Muscle strength was 5/5 bilaterally.  The VARD assigned a disability rating of 10%.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under the 5243 code (intervertebral disc syndrome) while the VA rated the condition 10%, coded 5243-5003.  There were no periods of physician prescribed bed rest for any rating under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes (5243).  The VA exam was more comprehensive and closer to separation and had the highest probative value for rating.  That exam was consistent with the totality of the record and warranted a 10% rating under the general spine formula.  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 lumbar spondylosis with degenerative disks condition.

The Board finally deliberated if additional disability was justified for peripheral nerve impairment.  The CI had symptoms of intermittent radiating pain to his anterior thighs.  However, there were no complaints of muscle problems, and objective peripheral nerve, muscle strength, and reflex testing was normal.  The presence of functional impairment with a direct impact on fitness is the key determinant in the Board’s decision to recommend any condition for rating as additionally unfitting.  Pain (whether or not it radiates), stiffness, or aching is rated under the general formula for the spine and was considered in the 5243 rating above.  There was insufficient evidence in this case of functional impairment attributable to peripheral neuropathy that adversely impacted duty performance.  The Board therefore concluded that no peripheral nerve (radiculopathy) condition could be recommended for additional disability rating.

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 lumbar spondylosis condition 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 20130915, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

		

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW BOARDS
Subj:	PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATION 
Ref:	(a) DoDI 6040.44
(b) CORB ltr dtd XX Jun 15

In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for the reasons provided in their forwarding memorandums, approve the recommendations of the PDBR that the following individual's records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy' s Physical Evaluation Board:

-	XXXXXXXXXXXXXXXXXXXX, former USN
-	XXXXXXXXXXXXXXXXXXXX, former USN
-	XXXXXXXXXXXXXXXXXXXX , former USN
-	XXXXXXXXXXXXXXXXXXXX, former USN