RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03313
BRANCH OF SERVICE:  NAVY	SEPARATION DATE:  20050816

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-3 (Hospital Corpsman) medically separated by the Informal Physical Evaluation Board for “low back pain”; with a combined disability rating of 20%.

CI CONTENTION:  “Please consider all conditions”

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  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 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 - 20050325	VARD – 20050816	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Lower Back Pain	5237	20%	Post-Operative…L4-5 Laminectomy and Discectomy	5299-5241	10%	STR	
S/P Left L4/5 Laminectomy…	Cat II					
		Radiculopathy, Left…Extremity	8520	0%	STR	
COMBINED RATING:  20%	COMBINED RATING FOR ALL VA CONDITOINS:  10%	

ANALYSIS SUMMARY:  The available evidence for this case did not contain a VA Compensation & Pension (C&P) examination for the CI was reported as a ‘no show’ for his scheduled appointment.  The pertinent historical medical information was obtained from a remote VARD summary as well as case file clinical encounter documents.

Low Back Pain.  The CI developed low back pain with left-sided radiculopathy in February 2004 after heavy lifting.  Radiographs revealed lumbosacral disc herniation as well as degenerative disc disease (DDD).  Despite 7 months of conservative treatment, his symptoms remained and he underwent spinal surgery in September 2004.  The service treatment record noted no change in the CI’s symptoms after surgery.  His back pain remained with intermittent bouts of left leg pain.  His final date of limited duty began on 02 June 2004.  A MEB commenced on 27 January 2005.

At the MEB narrative summary (NARSUM) (3 months pre-separation) the CI’s history was chronicled with ever present low back pain.  He endorsed the inability to sit or stand for a prolonged period of time.  The physical examination noted decreased thoracolumbar flexion to “60%” (approximately 55 degrees); combined ROM of 205 (normal 240) and ‘slight’ decreased sensation in the back of the left leg and foot.  Strength, instability tests, and gait were normal.  There was no comment in regards to the presence of painful motion.

The Board directed its attention to its rating recommendation based on the above evidence.  Although the service and VA titled the unfitting back condition slightly differently, they both utilized similar primary codes of 5237 (Lumbosacral strain) and 5241 (Spinal fusion) respectively; with the PEB citing no specific reason and the VA citing limited ROM.  Board members first agreed that the only examination near the time of separation that contained VASRD criteria such as range-of-motion was the MEB NARSUM and therefore, exclusive exam probative value was apportioned to that evaluation.  The documented 60% of forward flexion equates to a rounded up 55 degrees and thus is supported at the 20% impairment level.  There were no available alternative or analogous coding options which were applicable and or advantageous to the CI’s current 20% 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’s adjudication for the low back condition.

Additionally, Board members considered and concluded that the recommended 4-hour workday was part of his recovery restrictions and did not meet VASRD criteria for incapacitating episodes.  The Board also considered if the symptomatic left lower extremity radiculopathy warranted additional disability rating; but, members agreed that the requisite link of the neuropathy symptoms with functional impairment was not in evidence.  The pain component of a radiculopathy is subsumed under the general spine rating as specified in §4.71a.  Considering all of the evidence and mindful of VASRD §4.3 (Reasonable doubt), members agreed that a disability rating of 20% for the LBP condition was appropriately recommended in this case.

Other PEB Condition. Status post left L4-5 laminectomy was adjudicated by the PEB as a related Category II condition.  The Board unanimously agreed that this condition was subsumed by the low back pain condition and therefore does not warrant consideration as separately unfitting condition.

BOARD FINDINGS:  In the matter of the low back 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 20140701 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 19 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:

		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN