RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02978
BRANCH OF SERVICE:  Navy 	SEPARATION DATE:  20090810

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated Reserve, E6, Personnel Specialist, medically separated for “spondylolisthesis…,” with a disability rating of 20%.

CI CONTENTION:  The applicant contends her back condition.  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 – 20090624	VARD – 20091027	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Spondylolisthesis, L4-5, Status Post Arthrodesis L4-5 Utilizing Pedicle Screws	5239	20%	Degenerative Disc Disease, L4-5 with Grade I Anterolisthesis S/P
Laminectomy and Facetectomy for Correction of Spondylolisthesis L4-5	5242-5239	10%	20091022	
Loss of Motion Lumbar Spine Secondary to Degenerative Disk Disease	Cat II					
Degenerative Disk Disease, L5-S1 with Narrowing and Osteophytic Changes	Cat II					
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Spondylolisthesis.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent back surgery for fusion at L4-L5 in October 2008 for low back pain (LBP) with bilateral sciatica.  At the time of the orthopedic clinic visit on 11 February 2009, 4 months after surgery, there was marked improvement in the sciatica, but the CI continued to report recurrent episodic LBP.  The exam noted no significant clinical deformity, no scoliosis or spasm and range of motion (ROM) was limited to 45 degrees flexion, 10 degrees extension, and 20 degrees rotation to each side.  Neurologically, the CI had no motor deficit or sensory-deficit.  Deep tendon reflexes were normal and symmetrical at the ankle and knee.  Lumbosacral spine X-rays showed a single level fusion at L4-5 and a second degree spondylolisthesis (forward slippage of the L4 vertebra on the L5 vertebra) at that same level.  The CI requested separation but the surgeon indicated that additional observation after surgery was required before consideration of a MEB.  Further treatment did not result in improvement sufficient to allow unrestricted duty and at the orthopedic clinic visit 27 April 2009, separation was recommended.  The MEB forwarded “spondylolisthesis congenital,” “degeneration of lumbar or lumbosacral inter vertebral disc” and “congenital anomaly of spine unspecified” for PEB adjudication.

The MEB NARSUM examination on 27 April 2009 (3 months prior to separation) noted complaint of LBP which was worsened by prolonged sitting, the CI had discontinued the use of a brace, but was limited from significant strenuous physical activity.  Physical exam showed that she moved about the examining room slowly and deliberately but her gait was not antalgic.  There was a benign surgical incision which was non-tender; however, she did have moderate tenderness to palpation at the L5-S1 level.  There was no scoliosis; however, there was a loss of a normal lumbar lordosis.  Lumbar spine ROM was limited to 45 degrees flexion, with pain.  

At the VA Compensation and Pension (C&P) Spine examination on 22 October 2009, performed 2 months after separation, the CI reported LBP that had persisted since the 2008 surgery but was improved, without lower extremity (LE) radiation or paresthesias.  There were no flare-ups or incapacitating episodes of spinal disease.  Physical exam showed a normal gait.  There was no abnormal spinal curvature or ankylosis.  There was tenderness and muscle spasm noted.  Thoracolumbar (TL) spine ROM was 75 degrees flexion and total combined ROM 215 degrees, with painful motion and no additional loss of ROM with repetition.  Lower extremity strength, sensation, and reflexes were normal and testing for radiculopathy was negative (Laseague’s)

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the spondylolisthesis condition 20% coded 5239 (spondylolisthesis or segmental instability).  The Navy PEB also listed “loss of motion lumbar spine secondary to degenerative disk disease” and “degenerative disk disease, L5-S1 with narrowing and osteophytic changes” as related category 2 conditions (a condition that contributes the primary unfitting condition but are not separately ratable).  The impairment from the loss of motion lumbar spine secondary to degenerative disk disease (DDD) and DDD, L5-S1 with narrowing and osteophytic changes are subsumed under the overall rating for the spondylolisthesis  and IAW VASRD §4.14 (Avoidance of pyramiding), more than one rating based on the same impairment is prohibited.  The VA rated the spondylolisthesis condition 10% coded 5242-5239 (spondylolisthesis or segmental instability), based on the VA C&P examination 2 months after separation, citing limitation of forward flexion.  
 
The PEB rated the back condition 20% and the Board reviewed the record to see if a higher rating than 20% was supported.  There was no evidence of TL flexion of “30 degrees or less” or TL ankylosis to warrant a higher rating.  The Board also considered whether a higher rating (§4.7) was achieved by using the alternate rating formula based on incapacitating episodes due to intervertebral disc syndrome.  The CI had intervertebral disc disease, however, there were no incapacitating episodes requiring bed rest prescribed by a physician to warrant consideration of rating under the alternate VASRD formula based on incapacitating episodes.  Although the back condition was associated with significant radicular symptoms prior to surgery, after surgery notes in the STR documented the bilateral sciatica had resolved.  At the MEB NARSUM and C&P exams the CI reported LBP without radiation and LE strength, sensation, and reflexes were normal.  At separation there was no evidence of ratable peripheral nerve impairment due to the back condition which would provide for additional rating.  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 spondylolisthesis condition.  

BOARD FINDINGS:  In the matter of the spondylolisthesis 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 20140624, 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 24 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 USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USMC 

						  	XXXXXXXXXXXXXXXXXXXX
	     				  		Assistant General Counsel
						 	(Manpower & Reserve Affairs)