RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03907
BRANCH OF SERVICE:  Navy 	SEPARATION DATE:  20080418

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a Reserve E4, Storekeeper, medically separated for “chronic low back pain,” with a disability rating of 20%.

CI CONTENTION:  The CI requested consideration of 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 – 20071113	VARD – 20081202	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5243	20%	Degenerative Disc Disease, Lumbar Spine, with Central Disc Herniation and Right Lower Extremity Radiculopathy	5243	10%	20080815	
Intermittent Right Leg Sciatica	Cat II					
Central Disk Herniation at L4-L5 with Degenerative Disk Disease also at L4-L5						
Right Plantar Fasciitis	Cat III	No VA Placement	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s back condition began while on deployment between the months of March and November 2006 without any specific injury or trauma.  Magnetic resonance imaging studies in December 2006 showed a central disk herniation at L4-L5, which mildly deformed the ventral thecal sac and encroached on the lateral recesses.  Additionally, there were moderate degenerative disc changes at L4-5 with a slight degree of retrolisthesis (a posterior displacement of one vertebra over an adjacent vertebra).  Evaluation by neurosurgery recommended non-surgical treatment.  Despite treatment with nonsteroidal anti-inflammatory drugs (NSAIDs), narcotics, physical therapy, and bilateral epidural steroid injections, the back condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for an MEB.  The MEB forwarded “lumbago,” “displacement of lumbar intervertebral disc without myelopathy,” “degeneration of lumbar or lumbosacral intervertebral disc,” and “sciatica,” for PEB adjudication.

The range of motion (ROM) examinations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.  

Thoracolumbar ROM
(Degrees)	MEB ~8 Mos. Pre-Sep
	VA ~4 Mos. Post-Sep
	VA ~9 Mos. Post-Sep
	
Flexion (90 Normal)	40	Examiner failed to provide results of ROM testing.  	40	
Combined (240)	160		140	
§4.71a Rating	20% (PEB 20%)	-	20% (VA 10%)	

The MEB NARSUM examination on 20 August 2007, performed 8 months prior to separation, noted complaints of constant back pain, with intermittent leg pain, and muscle spasms when the CI stood for too long or performed too much work or activity.  She occasionally had muscle spasms in the back and leg and had pain shooting down her leg into her foot with occasional numbness and tingling in the foot, but there was no bowel or bladder problems or weakness in the lower extremities.  Physical examination showed no abnormalities, no tenderness to palpation, and a negative straight leg raise test (to determine nerve root irritation).  ROM measurements were flexion of 40 degrees (90 normal) with a combined ROM of 160 degrees (240 normal).  Deep tendon reflexes were a trace at the knee and at the ankle bilaterally otherwise the neurological evaluation was unremarkable.  X-rays of the lumbar spine showed mild to moderate degenerative disk disease at L4-L5 and a slight degree of retrolisthesis.

At the 15 August 2008 VA Compensation and Pension (C&P) evaluation, performed 4 months after separation, the CI reported that prolonged standing, bending or lifting aggravated her back condition.  Physical examination showed objective evidence of guarding, pain on motion, and tenderness.  The CI’s posture and gait were normal, and there was no ankylosis.  Testing in September 2008 for radiculopathy was positive for the right leg, but there was no evidence of neuropathy.  The examiner did not provide results of ROM testing; however, a subsequent examination was performed on 29 January 2009 (9 months after separation) revealed flexion of 40 degrees and a combined ROM of 140 degrees.   In February 2009, 10 months post-separation, because of intractable back pain, the CI underwent an L4-L5 decompressive laminectomy and a posterior lumbar interbody fusion with peak spacers.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 20%, coded 5243 (intervertebral disc syndrome).  The Navy PEB listed the “intermittent right leg sciatica” and “central disk herniation at L4-L5 with degenerative disk disease also at L4-L5” as related Category II conditions that contributed to the overall disability in this case.  The VA rated the back condition 10% coded 5243 (intervertebral disc syndrome), based on the VA C&P examination 4 months after separation, citing painful motion.  The Board agreed that a 20% rating, but no higher, was justified for limitation of flexion (greater than 30 degrees but not greater than 60 degrees) reported on the MEB NARSUM and VA examinations.  The Board also considered whether an additional disability rating was justified for peripheral nerve impairment due to radiculopathy.  Radiographic and electrodiagnostic studies supported some level of radicular nerve irritation or involvement, but physical examinations (MEB NARSUM, and VA C&P) proximate to separation revealed no objective findings of a significant 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 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 or sensory deficit which would impact military occupation-specific activities.  There was no evidence in this case that motor weakness or sensory deficit 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 “chronic low back pain” condition.  The Board agreed that the Category II conditions of “intermittent right leg sciatica” and “central disc herniation at L4-L5 with degenerative disk disease at L4-L5” were the underlying diagnoses causing and contributing to the “chronic low back pain” condition and were not separately unfitting conditions IAW §4.14 (avoidance of pyramiding; more than one rating based on the same impairment is prohibited), and were, therefore, not ratable and noncompensable.
 
Contended PEB Conditions:  Right Plantar Fasciitis.  The Board’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The contended condition was not profiled or implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the chronic low back pain condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended right plantar fasciitis condition, the Board unanimously recommends no change from the PEB determinations as not unfitting.  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 20140829, w/attachments
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 8 Aug 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 USN
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USMC

						XXXXXXXXXXXXXXXXXXXX
	     				  	Assistant General Counsel
						(Manpower & Reserve Affairs)