RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01840
BRANCH OF SERVICE:  Navy 	SEPARATION DATE:  20061011

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Airman, medically separated for “lumbar disc degenerative L4-L5,” with a disability rating of 20%.  

CI CONTENTION:  The CI made no specific contention in the application.  The CI’s complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited 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 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:  

SERVICE PEB - 20060719	VARD - 20061207	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Lumbar Disc Degenerative L4-L5	5237	20%	Discogenic Disease, Lumbosacral Spine, Status Post Laminectomy	5238-5242	10%	20060814	
			Radiculopathy, Right Lower Extremity Associated with Discogenic Disease, Lumbosacral Spine, Status Post Laminectomy	8520	20%		
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Lumbar Disk Degenerative L4-L5.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the L4-L5 degenerative disc disease with radiation to both legs began in January 2004.  The CI denied any specific injury or trauma.  Magnetic resonance imaging (MRI) studies in January and December of 2004 documented multilevel intervertebral disc disease most significant at the L4-L5 level, resulting in moderate to severe central canal stenosis and narrowing of the neuroforamina (space through which the spinal nerve root passes).  The CI received epidural steroid injections with only temporary relief.  Surgery (L4-L5 laminectomy and discectomy) was performed in January 2006.  Following surgery, further treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “lumbago,” “spinal stenosis of unspecified region,” “degeneration of lumbar or lumbosacral intervertebral disc,” “thoracic or lumbosacral neuritis or radiculitis, unspecified,” and “displacement of lumbar intervertebral disc without myelopathy” for PEB adjudication.  

At the MEB NARSUM examination on 22 May 2006 (5 months prior to separation), the CI reported low back and bilateral lower extremity pain.  The pain was aggravated by walking, sitting, standing for long periods, carrying heavy loads, and high activity exercises.  Physical examination showed a forward flexion of 50 degrees (normal 90) and a total combined range of motion (ROM) of 100 degrees (normal 240).  Gait, spinal contour and strength were all normal.   There was decreased sensation in the L5 nerve distribution of the right lower extremity with evidence of nerve irritation (“mild” clonus), however, provocative maneuvers for signs of radiculopathy (radiating pain due nerve root involvement) were negative.  

At the VA Compensation and Pension (C&P) examination in August 2006, performed 2 months before separation, the CI reported daily pain with associated weakness, lack of endurance, and persistent numbness in the dorsal foot.  The pain radiated 4-5 times weekly to the right foot.  The condition affected employment, recreational basketball, and housekeeping; however, he denied any periods of incapacitation in the previous 12 months.  X-ray studies showed the L4 surgical defect, normal intervertebral disc spacing and alignment, and no evidence of fracture, subluxation or degenerative changes.  Physical examination showed a normal gait and posture.  ROM measurement were recorded as flexion to 90 degrees (90 normal), and combined ROM of 195 degrees (normal 240), with painful motion.  There were no further decrements after repetition.  There was reduced sensation and strength (not quantified) of the right foot.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 20% rating under the 5237 code (lumbosacral strain).  The PEB also listed “spinal stenosis, lumbar radiculopathy, herniated lumbar disc, and lumbago” as related (Category 2) diagnoses contributing to the disability in this case.  The VA assigned a 10% rating using an analogous 5238-5242 code (spinal stenosis-degenerative arthritis of the spine) based pm the VA C&P examination 2 months before separation, citing limited and painful motion.  The VA additionally identified “radiculopathy, right lower extremity associated with discogenic disease lumbosacral spine, status post laminectomy,” rated 20% under the 8520 code (paralysis of sciatic nerve) citing evidence of sensory deficits of the foot.  

The Board noted that the all of the Category II conditions listed by the PEB were interrelated with the Category I unfitting condition and were not separate conditions which could be separately rated (§4.14 avoidance of pyramiding).  The Board deliberated the evidence for a higher rating.  The MEB NARSUM examination documented a flexion of 50 degrees, in support of the 20% rating criteria for forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees.  There was no evidence of forward flexion of the spine to 30 degrees or less in support of a higher rating.  There was no documentation of incapacitating episodes of at least 4 weeks but less than 6 weeks which would provide for a higher rating under that formula.  

The Board also considered if an additional disability rating was justified for peripheral nerve impairment due to radiculopathy.  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.  The CI reported radiating pain, sensory loss and weakness.  The MEB NARSUM examination documented decreased sensation of the right foot with normal strength and reflexes that did not affect his job.  The VA C&P examination reported nonspecific deficits of strength and sensation.  There were no objective findings (electrodiagnostic studies) in evidence documenting radiculopathy that would impact duty performance.  While the CI may have suffered additional pain from the nerve involvement, this is subsumed under the general spine rating criteria, which specifically states “with or without symptoms such as pain (whether or not it radiates).”  Therefore the critical decision is whether or not there was a significant motor weakness which would impact his military duties.  There is no evidence in this case that motor weakness existed to any degree that could be described as functionally impairing.  The Board therefore concluded that an additional disability rating was not justified on this basis.  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 L4-L5 degenerative disc condition.  

BOARD FINDINGS:  In the matter of the L4-L5 degenerative disc 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.  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 20140428, 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 31 May 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:

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

								XXXXXXXXXXXXXXXXXXXX	     				  					Assistant General Counsel
								(Manpower & Reserve Affairs)