RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-04279
BRANCH OF SERVICE:  Navy	SEPARATION DATE:  20061109

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

CI CONTENTION:  Should be given a higher disability rating.  Her 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 - 20060710	VARD - 20070725	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Mechanical Low Back Pain	5299-5242	10%	Lumbar Strain with DJD and Lumbago	5242	10%	20070320	
Stress Urinary Incontinence	Cat II	Incontinence	7512	0%	20070320	
Uterine Prolapse with Cystocele and Rectocele	Cat II	Uterine Prolapse	7621	NSC	20070320 	
Obesity	Cat II	No VA Placement	
Partial Sacralization L5 Vertebrae	Cat II	No VA Placement	
Degenerative Disc Disease	Cat II	No VA Placement	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:

Mechanical Low Back Pain.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s back condition began in October 2001.  The CI denied any specific injury or trauma.  Diagnostic imaging (MRI) in March 2004 showed no evidence of significant disc bulge.  At the time of the chiropractic clinic appointment on 31 March 2006, 7 months before separation, the CI reported back pain radiating into her thighs.  The examiner recorded that she “appeared uncomfortable [and was] shifting in her chair frequently due to low back pain.”  On examination she had “mild-moderately increased lordosis,” tenderness to palpation of the lumbosacral spine, and spasms in the bilateral paraspinal muscles.  Range of motion (ROM) was limited to flexion 65 degrees (normal 90 degrees) with painful motion.  At the time of the orthopedic appointment on 11 May 2006, 6 months prior to separation, the examiner recorded increased paresthesia with activity on left side.  On examination she had hyper-lordosis, tenderness to palpation of the left lumbar spine, and decreased sensation.  She could touch her fingers to the floor and her straight leg test was negative.  She was diagnosed with mechanical low back pain due to degenerative disc disease.  Despite treatment, 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 MEB.  The MEB forwarded “backache, unspecified” and “degeneration of intervertebral disc, site unspecified” for PEB adjudication.

The MEB NARSUM examination on 18 May 2006, also 6 months prior to separation, noted complaints of increasing pain and paresthesia to the left side without bowel or bladder symptoms.  Physical examination noted “hyperlordosis and…excellent ROM.”  Spinal tenderness to palpation was present.  Ankle reflexes were absent, but knee reflexes were intact.  Straight leg raise test was negative and sensation was intact.  At the MEB examination dated 31 May 2006, 5 months prior to separation, the CI reported losing feeling from the waist down on the left after putting her foot through a fish tank.  Physical examination showed left lower extremity weakness with sensory changes and decreased left lower extremity strength.  There was lumbar paraspinal muscle tenderness to palpation and pain on motion.

At the VA Compensation and Pension (C&P) examination on 20 March 2007, performed 4 months after separation, the CI reported intermittent bouts of left-sided sciatica with pain during prolonged standing or walking.  Physical examination showed ROM of flexion to 90 degrees and combined ROM to 235 degrees (normal 240 degrees) without pain, lack of endurance, fatigue or weakness on repetition.  Motor strength, sensation, reflexes, gait and posture were normal.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back condition 10%, analogously coded 5242 (degenerative arthritis of the spine).  The VA also rated the back condition 10%, also coded 5242 based on the VA C&P examination 4 months after separation, citing painful reduced range of motion.

The Board agreed that a 10% rating, but no higher, was justified for limitation of combined ROM greater than 120 degrees but not greater than 235 degrees reported on the VA examination proximate to separation.  There was no evidence of muscle spasm or guarding severe enough to result in abnormal gait or spinal contour on the examinations most proximate to separation, thus the next higher 20% rating was not justified on this basis.  There was no associated radiculopathy for separate peripheral nerve rating.  While the CI may have experienced radiating pain from the back condition, this is subsumed under the general spine rating criteria, which specifically states “with or without symptoms such as pain (whether or not it radiates).”  There was no objective evidence of a radiculopathy with functional impairments such as weakness with a direct impact on fitness that were separately functionally impairing for duty.  The Board therefore concluded that additional disability rating was not justified on this basis.  The PEB also listed “partial sacralization L5 vertebrae” and “degenerative disc disease” as related Category II conditions that contribute to the primary unfitting condition but are not separately ratable.  The impairment from these conditions is subsumed under the overall rating for the “mechanical low back pain condition.” (§4.14 avoidance of pyramiding; more than one rating based on the same impairment is prohibited).

The Board also deliberated the Category II stress urinary incontinence, uterine prolapse with cystocele and rectocele, and obesity conditions.  The Board agreed these conditions are not subsumed under the low back condition.  The stress urinary incontinence and uterine prolapse were reviewed and considered by the Board.  There was no performance based evidence from the record that either of these conditions significantly interfered with satisfactory duty performance.  The MEB NARSUM indicated that the CI did “not complain of any bowel or bladder symptoms.”  After due deliberation and in consideration of the preponderance of the evidence, the Board concluded that the CI’s incontinence and uterine prolapse were not separately unfitting and so no additional disability ratings are recommended.  Regarding the obesity condition, IAW DoDI 1332.38, Enclosure 5, this condition does not constitute a physical disability and, therefore, is not a ratable condition.

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 mechanical low back pain condition.

BOARD FINDINGS:  In the matter of the mechanical 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 “partial sacralization L5 vertebrae” and “degenerative disc disease” conditions, the Board unanimously recommends no change from the PEB determinations as Category II conditions.  In the matter of the contended stress urinary incontinence, uterine prolapse with cystocele and rectocele conditions, and obesity conditions, the Board unanimously agrees they were not unfitting and cannot be recommended for additional disability rating.  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 20141115, 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 20 Oct 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 USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN

						  XXXXXXXXXXXXXXXXXX	     				  			  		Assistant General Counsel
						(Manpower & Reserve Affairs)