RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-04191
BRANCH OF SERVICE:  Navy 	SEPARATION DATE:  20051228

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Radio Frequency Equipment Operator, medically separated for “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 upon a 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 - 20051019	VARD - 20061114	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Low Back Pain	5299-5237	20%	Degenerative Disc Disease L4-5 and L5-S1 with Annular Bulging at L5-S1	5243	20%	20061025	
Degenerative Disc Disease	Cat II					
Herniated Nucleus Pulposus	Cat II					
Right Lower Extremity Radiculitis	Cat II					
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Low Back Pain.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s low back pain condition began in April 2004 after twisting and turning around pipes.  Diagnostic imaging (X-ray) studies on 11 May 2004 showed bone spurring, with slight loss of vertebral height at T11, T12, and L1, normal disc spacing, and no fractures or signs of trauma.  Magnetic resonance imaging (MRI) studies in July 2004 showed L4-L5 disc herniation with nerve root impingement and an L5-S1 disc bulge.  The CI received epidural steroid injections twice in December 2004 and again in January 2005.  A procedure to treat the L4-5 disc herniation (nucleoplasty) was performed in April 2005.  These interventions did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “lumbago,” “displacement of lumbar intervertebral disc without myelopathy,” “thoracic or lumbosacral neuritis or radiculitis, unspecified,” and “degeneration of lumbar or lumbosacral, intervertebral disc,” for PEB adjudication.  

At the MEB NARSUM examination dated 18 August 2005, 4 months pre-separation, the CI reported low back pain that radiated down his right lower extremity (LE) with associated numbness and tingling.  The pain prevented him from standing or sitting for prolonged periods and functioning at work.  Physical examination showed normal gait, strength, and reflexes without spasm.  Forward flexion was to 45 degrees (normal 90) with pain.  Straight leg raise testing (for radiculopathy) produced radiating pain in the right LE.  A lumbar discography in September 2005, 3 months pre-separation, confirmed persistence of the L4-5 disc herniation with radiation into the leg.  Electrodiagnostic studies performed in August 2006, 8 months post-separation, were negative for radiculopathy.  

At the VA Compensation and Pension (C&P) examination on 25 October 2006, 10 months post-separation, the CI reported pain, rated 6-7/10 that increased to 10/10 and occasionally radiated down the right leg, affected his ability to walk.  The pain was aggravated by driving, prolonged walking and standing, bending, lifting, and prevented him from playing basketball or golf.  Physical examination showed normal gait, sensation, reflexes, and strength.  There was tenderness of the right lumbar area.  Flexion was to 65 degrees with pain and no changes after repetition.  Straight leg raise testing produced radiating pain to the right buttock.  

The Board directed attention to the rating recommendation based on the above evidence.  The PEB rated the low back pain condition 20% coded 5299-5237 (lumbosacral strain).  The Navy PEB also listed the right LE radiculitis, degenerative disc disease (DDD), and L4-5 herniated nucleus pulposus conditions as related category II conditions (conditions that contributed to the primary unfitting condition but were not separately ratable).  The impairment from the right LE radiculitis, DDD, and L4-5 herniated nucleus pulposus conditions were properly subsumed under the overall rating for the low back pain condition IAW §4.14 (avoidance of pyramiding; more than one rating based on the same impairment is prohibited).  The VA also rated the low back pain condition 20% coded 5243 (intervertebral disc syndrome), based on the VA C&P examination 10 months after separation, citing pain and limitation of 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 examination.  There was no evidence of forward flexion of the spine to 30 degrees or less in support of a higher rating.  There was no evidence to support a duty limiting nerve root impingement or radiculopathy for consideration of a separately unfitting rating.  Pain, whether or not it radiates, is considered under the general rating formula of the spine.  There was no documentation of persistent ankylosis of the spine, or incapacitating episodes (physician prescribed bed rest) approximating 6 weeks, or other evidence that would support a higher 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 low back pain condition.  

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.  In the matter of the contended right LE radiculitis, DDD, and L4-5 herniated nucleus pulposus conditions, the Board unanimously recommends no change from the PEB determinations as Category II conditions.  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 20140801, 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 11 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 USN
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN