RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2014-00141
BRANCH OF SERVICE:  NAVY  	SEPARATION DATE:  20060828

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-6 (Electronics Technician) medically separated for a back condition.  The condition could not be adequately rehabilitated to meet the physical requirements of his Rating.  He was placed on limited duty and referred for a Medical Evaluation Board (MEB).  The “lumbosacral spondylosis without myelopathy” was forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E.  No other condition was submitted by the MEB.  The Informal PEB adjudicated “L5/S1 grade II spondylolistheses” as unfitting, rated 20%.  The CI made no appeals and was medically separated.  

CI CONTENTION:  “The problem in my back is much larger of an effected area, S1, L5, L4, L3 my asthma has increased severly [sic], lots of difficulty sleeping, difficult to walk, stand sit.  Never ending pain.” 

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 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:  

IPEB - Dated 20060719	VA* - (~9 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
L5/S1 Grade II Spondylolistheses	5239	20%	Spondylolistheses L5-S1	5239	10%	20070515	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 0 	
RATING:  20%	RATING:  10%	
*Derived from VA Rating Decision (VARD) dated 20070628(most proximate to date of separation [DOS]).  

ANALYSIS SUMMARY:  

L5/S1 Grade II Spondylolisthesis.  The service treatment record (STR) and narrative summary (NARSUM) documented low back pain that started after a motor vehicle accident in November 2000.  The STR was silent for back pain through May 2003 (3 years prior to separation), when radiographs were obtained for “occasional” low back pain and documented bilateral L5 spondylosis (degeneration) with Grade I-II spondylolisthesis (25-50% slippage of the vertebrae).  Radiologic imaging in June 2005 (14 months prior to separation) documented moderate to severe bilateral L5-S1 foraminal stenosis [narrowing of the nerve canal exiting from the spine].  At a visit in August 2005 (12 months prior to separation), the CI reported 4 years of low back pain, worsening over the previous year, accompanied by left lower extremity pain with occasional weakness and numbness.  The examiner documented no tenderness to palpation of the lumbosacral spine with normal strength, sensation of the lower extremities.  Flexion was to 90 degrees (normal), with extension and bilateral lateral bending to 20 degrees each (normal 30).  During a visit to the pain management service in September 2005 (11 months prior to separation), the CI reported pain worsening over the last year with radicular symptoms in the left lower extremity.  The examiner documented “no motor or sensory deficits” and treated with an epidural steroid injection (ESI).  Radiographic imaging in December 2005 (8 months prior to separation) documented spondylolisthesis [slippage] of the L5 vertebrae, causing narrowing of the foramen [where the nerve exits the spine].  At another visit with the pain management service in December 2005, the CI reported no relief from the initial ESI.  The examiner documented tenderness of the spine and pain during extension and rotation of the spine.  At a physical therapy consultation in March 2006  (5 months prior to separation), the CI reported constant 4/10 pain radiating to the left buttock and each ankle, aggravated by walking, and denied sensory changes.  The examiner documented normal gait, normal flexion and side bending without pain.  Rotation resulted in increased symptoms.  Strength was 5/5 bilaterally.  

At a physical therapy session in April 2006 (4 months prior to separation), the examiner documented “trunk range-of-motion within full limits,” and movement “bothers” the lumbar area.  At an orthopedic visit in May 2006 (3 months prior to separation), the examiner documented a normal gait, no midline or paraspinal muscle tenderness, and negative nerve tension testing.  Flexion was “to the ankles” (normal 90 degrees), extension was 20 degrees (normal 30), with bilateral lateral bending and bilateral rotation to 30 degrees each (normal).  Strength, sensation, and neurologic exams were normal.  Radiographs at that visit documented a grade II spondylolisthesis (25 to 50 % slippage) and pars defect (fracture) of the L5. The examiner opined that his radiographs were unchanged from prior radiographs in Dec 2005 and that the condition was “stable over time.”  At an orthopedic referral in May 2006, the CI reported no lower extremity symptoms and a moderate degree of low back symptoms, described as “tolerable.”  The examiner documented a normal neurologic exam, no focal motor deficits, normal sensation throughout, and negative nerve tension testing.  The examiner opined that surgery was an option if he developed neurologic symptoms or if the pain became more significant.  There was no STR documentation of physician prescribed bed rest for incapacitating episodes and no documentation of more significant range-of-motion deficits.  

The MEB NARSUM exam was performed on 13 June 2006 (2 months prior to separation).  The CI reported 4/10 pain, with occasional radicular symptoms radiating to his left buttock, and denied numbness or weakness of the lower extremities.  The examiner documented the May 2006 orthopedic exam.  On the MEB DD Form 2807-1, Report of Medical History, dated 26 June 2006 (2 months prior to separation), the CI reported that his condition caused trouble sleeping.  On the MEB DD Form 2808, Report of Medical Examination, dated 26 June 2006, the examiner checked “normal” for the spine exam.  

At the VA Compensation and Pension (C&P) exam dated/performed on 15 May 2007 (9 months after separation), the CI reported no use of assistive devices, no loss of work due to back problems and no periods of incapacitation.  He reported daily 2-3/10 pain with momentary flares once a month.  He reported problems with walking around the block and bathing his children; and that he was able to do everything he attempted to do, with pain.  The examiner documented a normal gait, tenderness over the L4-L5 area with no spasm noted.  There was normal strength, normal sensation, negative nerve tension testing and a normal neurologic exam.  Flexion was to 80 degrees; extension to 25 degrees; bilateral flexion was normal with pain; right rotation to 25 degrees with normal left rotation; all with pain.  

The Board directed attention to the rating recommendation based on the above evidence.  The PEB adjudicated the L5-S1 Grade II spondylolisthesis as unfitting, rated 20% coded 5239 (spondylolisthesis).  The VA rated 10% based on the post-separation exam and citing no evidence in the STR for a higher rating.  The Board considered the evidence for a higher rating.  There was no evidence of ankylosis or flexion of the thoracolumbar spine to 30 degrees or less; and no evidence of incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the 12 months prior to separation to support a higher than 20% rating.  There was no documentation of flexion greater than 30 degrees but not greater than 60 degrees; and no evidence of a combined range-of-motion of the thoracolumbar spine not greater than 120 degrees.  There was no documentation of muscle spasms or guarding severe enough to result in an abnormal gait, spinal contour, or abnormal kyphosis.  The Board considered whether additional Service rating could be recommended under a peripheral nerve code for the radicular symptoms, but members agreed that the functional link to fitness requisite for Service rating was not supported by the evidence.  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 low back condition.  

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 L5/S1 Grade II spondylolisthesis 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 20131222 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) RECOMMENDATIONS
 
Ref:   (a) DoDI 6040.44
       (b) CORB ltr dtd 6 Jan 16

      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:

- XXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXXX, former USMC  
- XXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXX, former USMC 
- XXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXX, former USN