RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02491
BRANCH OF SERVICE:  Navy 	SEPARATION DATE:  20041123

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Sonar Technician, medically separated for “post traumatic mechanical low-back syndrome,” with a disability rating of 10%.

CI CONTENTION:  “Please consider all conditions.”  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 based on 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 - 20040716	VARD - 20050208	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Post Traumatic Mechanical Low Back Syndrome	5237	10%	Chronic Lumbar Strain with Right Sciatica	5237	10%	20040713	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Post Traumatic Mechanical Low-Back Syndrome.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), this CI’s low back pain (LBP) began in early 2000, after falling.  X-ray studies, in May 2002 and February 2004, showed a normal lumbar spine, with no evidence of acute disease.  In March 2004, magnetic resonance imaging revealed bulging discs at multiple lumbar levels.  There was some central canal stenosis due to congenital narrowing of the central canal.  There was no herniated nucleus pulposus, and no impingement on nerve structures.  Bone Scan, on 5 May 2004, was normal.  The CI was treated with medication, physical therapy, and other therapeutic measures.  In spite of all treatment efforts, his LBP persisted and an MEB was initiated.  The MEB forwarded “Post-traumatic mechanical low-back syndrome” to the PEB for adjudication.  The range of motion (ROM) examinations in evidence which the Board weighed in arriving at its recommendation, are summarized below.  

Thoracolumbar ROM
(Degrees)	NARSUM ~6  Mo. Pre-Sep
(20040511)	VA C&P ~4 Mo. Pre-Sep
(20040713)	
Flexion (90 Normal)	50	75	
Combined (240)	200	185	
Comments	Painful motion	Painful motion	

During the MEB examination dated 11 May 2004, 6 months prior to separation, the CI reported localized LBP, with occasional radiation to his testes and right foot.  The pain affected his daily activities, including standing for long periods.  He denied any numbness or weakness in the lower extremities.  The LBP prevented him from crossing his legs on the left side.  Physical examination showed an abnormal gait, with normal strength and sensation.  Straight leg raise (SLR) was negative for any radicular symptoms.  X-ray studies in July 2004 showed normal lumbar alignment with no fracture or dislocation.

At the 13 July 2004 VA Compensation and Pension (C&P) evaluation, performed 4 months before separation, the CI reported constant pain, which radiated down his legs.  The pain was described as sharp and sticking, and was 7/10 in severity.  The pain was aggravated by standing and walking for long periods.  It was relieved by rest and medication (gabapentin).  He also reported a history of incapacitating episodes, which had resulted in time lost from work.  Physical examination showed normal gait, with no spasm or tenderness.  Provocative maneuvers for signs of radiculopathy or radiating pain due to spinal nerve root involvement were negative.  Thoracolumbar ROM was measured, and is summarized in the chart above.    

The Board directed attention to its rating recommendation based on the above evidence.  The PEB chose VASRD code 5237 (lumbosacral strain), and rated the LBP condition at 10%.  The VA also used code 5237, and assigned a 10% disability rating, citing limitation of forward flexion and combined range of motion.  The Board considered the back examinations described above.  The July 2004 C&P exam was 4 months before the date of separation, and had significant probative value.  At that exam, forward flexion was 75 degrees, and combined thoracolumbar ROM was 185 degrees.  IAW the VASRD §4.71a General Rating Formula for Diseases and Injuries of the Spine, a 10% rating is warranted for thoracolumbar forward flexion greater than 60 degrees, but not greater than 85 degrees.  A 10% rating is also warranted for combined thoracolumbar ROM greater than 120 degrees, but not greater than 235 degrees.  The Board determined that a 10% rating, was justified for limitation of flexion (greater than 60 degrees, but not greater than 85 degrees) and limitation of combined thoracolumbar ROM (greater than 120 degrees, but not greater than 235 degrees).  
  
The Board also considered if additional disability rating was justified for peripheral nerve impairment due to radiculopathy.  The CI reported radiating pain down his legs; however, physical examinations proximate to separation showed insufficient evidence of radiculopathy that would impact duty performance.  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.  While the CI may have suffered 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 military duties.  There was insufficient 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.

There was no muscle spasm or guarding severe enough to result in abnormal gait or abnormal spinal contour, thus a higher rating of 20% rating was not justified on that basis.  The CI reported a history of incapacitating episodes, but the STR showed insufficient evidence of incapacitating episodes that would meet the standard set forth in the VASRD (periods of acute signs and symptoms due to intervertebral disc syndrome, that required bed rest prescribed by a physician, and treatment by a physician).  Therefore the CI did not qualify for a higher rating under diagnostic code (DC) 5243.  After due deliberation, in consideration of all the evidence, and mindful of VASRD §4.3 (reasonable doubt), the Board found insufficient cause to recommend a change in the PEB adjudication of the LBP condition.  

BOARD FINDINGS:  In the matter of the LBP condition and IAW VASRD §4.71a, the Board majority recommends no change in the PEB adjudication.  The single voter for dissent recommended modification and did not elect to submit a minority opinion.  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 20140519, 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 1 Jun 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 USMC
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN

						  XXXXXXXXXXXXXXXXXXXX
	     				 	 Assistant General Counsel
						  (Manpower & Reserve Affairs)