RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02163
BRANCH OF SERVICE:  NAVY	SEPARATION DATE:  20050428

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Information Systems Technician, medically separated for “low back pain,” with a disability rating of 10%.

CI CONTENTION:  The applicant makes no specific contention in her 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, 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 PEB - 20050121	VARD - 20050516	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Low Back Pain	5237	10%	Intermittent Symptomatic Thoracolumbar Paraspinal Tendinitis with Associated Degenerative Disk Disease	5242	10%	20050209	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Low Back Pain.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s low back pain condition began in 2001; there is no report of specific injury or trauma.  Radiographic studies showed degenerative disc disease.  There was no surgical indication.  Despite treatment including physical therapy and three epidural steroid injections, the CI’s back condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and was referred for a MEB.  

At the time of the neurosurgery clinic appointment on 24 September 2004, the CI reported pain as a constant dull ache, 5/10 on a bad day, exacerbated by walking or sitting.  She denied any weakness, but indicated she experiences intermittent pain into the bilateral buttocks, but that this happened “very very rarely” and did not last long.  The examiner recorded normal gait and muscle strength, no tenderness and X-ray/imaging including a magnetic resonance image (MRI) dated November 2003 demonstrated degenerative disc disease without neural impingement.  

The MEB NARSUM exam on 11 November 2004 (6 months prior to separation) noted complaints of a dull mostly constant ache worse when walking and sitting.  Physical exam showed a normal gait and normal muscle strength with intact sensation to light touch throughout.  There was no tenderness.  The examiner stated the CI had “good range of motion in her lumbar spine and is able to bend forward and touch her toes easily.”  The ROM was forward flexion of “approximately 90” degrees (normal 90) with extension of 20 degrees (normal 30) and is summarized above.  The examiner noted that a MRI from 1 November 2004 indicated significant degenerative disc disease without neural impingement, spondylolisthesis or instability at any of the joints on flexion or extension.  There was a small disc herniation slightly indenting the thecal sac at L4-5 and at L5-S1.  

At the VA Compensation and Pension (C&P) examination on 9 February 2005, performed 3 months before separation, the CI reported pain levels reaching 10/10 described near constant with discomfort exacerbated with bending, twisting, heavy lifting, standing for long periods of time or sitting for long periods of time.  She denied any lower extremity paresthesias (abnormal sensations), bowel or bladder dysfunction, decreased muscle strength, or gait disturbances.  Physical exam showed appreciable radiating pain on movement without muscle spasm or tenderness to palpitation, but no signs of radiculopathy and or evidence of intervertebral disk syndrome.  The ROM indicated pain on movement and is charted above.  At the C&P examination on 20 March 2006, performed 11 months after separation, the CI reported pain level 6-7/10, sharp and constant with no distribution into the lower extremities and no paresthesias.  Physical exam showed no muscle spasms, normal curvature and moderate bilateral paralumbar guarding with defuse tenderness.  The ROM was not associated with pain or additional limitations with additional repetitive use and is summarized above.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under code 5237 (lumbosacral strain).  The VA initially also assigned a 10% rating using code 5242 (degenerative arthritis of the spine) based on the VA C&P examination 3 months before separation, citing functional loss due to pain.  The VA subsequently assigned a 20% rating using the 5242 code based on the VA C&P examination 11 months after separation, citing limitation of forward flexion.  There is a disparity between examinations with implications for the Board's rating recommendation.  The Board deliberated the probative value of these conflicting evaluations, and carefully reviewed the entire file for corroborating evidence.  None of the evidence prior to separation (including the pre-separation VA exam) approximated the limitation of motion noted at the 11-month post-separation VA exam, and most pre-separation ROM evaluations documented either full or nearly normal ROM.  The Board adjudged that the pre-separation VA exam had the highest probative value for rating at separation.  

There was no associated radiculopathy for separate peripheral nerve rating.  Although the CI experienced radiating pain, there was no objective evidence of a radiculopathy or functional impairment with a direct impact on fitness.  While the CI may have experienced radiating pain from the back condition, this is subsumed under the general spine rating criteria, which specifically states “with or without symptoms such as pain (whether or not it radiates).”  There is no evidence in this case that there was radiculopathy with associated functional impairments separately functionally impairing.  The Board therefore concludes that additional disability rating was not justified on this basis.  Considering the totality of the evidence and mindful of VASRD §4.3 (reasonable doubt), members agreed that a disability rating of 10% for the low back pain condition was appropriately recommended in this case.  

BOARD FINDINGS:  In the matter of the low back pain 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 18 Apr 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 USN
		- XXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXX, former USN