RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00103
BRANCH OF SERVICE:  Navy 	SEPARATION DATE:  20050605

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Aviation Electronics Technician, medically separated for “lumbar disc herniation L4-5,…degenerative disc disease…” with a disability rating of 10%.  

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 – 20050224	VARD – 20050627	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Lumbar Disc Herniation L4-5, Degenerative Disc Disease L4-5 and L5/S1 	5243	10%	Lumbar Spine Degenerative Disc Disease with Disc Herniation L4-5 L4 and L5 –S1 	5243	20%	20050414	
			Left Lower Extremity Sciatic Radiculopathy	8620	20%	20050414	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Lumbar Disc Herniation L4-5, Degenerative Disc Disease L4-5 and L5/S1.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s low back pain condition began in September 2003 after bending and heavy lifting while repairing an aircraft.  Magnetic resonance imaging (MRI) studies showed a small L4-5 central protrusion slightly eccentric to the left and a smaller L5-S1 central disc bulge, with degenerative disc disease (DDD).  Evaluation by neurosurgery on 4 November 2003 (19 months prior to separation) concluded with a diagnosis of “mechanical low back pain” and recommended non-surgical treatment.  There was no surgical indication, and conservative treatment, which included a series of epidural steroid injections did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “displacement of lumbar intervertebral disc without myelopathy” and “degeneration of lumbar or lumbosacral intervertebral disc” for PEB adjudication.  

The MEB NARSUM examination on 1 October 2004 (8 months prior to separation) noted complaints of low back pain (LBP) and radiating left leg pain.  The CI had intermittent and occasional numbness and his left leg was heavy, sometimes giving out.  He denied weakness.  Physical examination showed tenderness in the lower lumbar spine. Straight leg raising (SLR) caused increased LBP on the left, but it did not cause radicular symptoms.  Motor test was normal (5/5) in all muscle groups, and reflexes were normal.  Sensation was intact to light touch and pin prick, although the DD Form 2808 from 27 September 2004 noted sensory deficit to light touch on the outside of the left thigh and medial leg.  The PEB was suspended for a neurosurgery update and submission of lumbar range of motion (ROM) in degrees.  The 23 February 2005 Joint Disability Evaluation Tracking System (JDETS) work card entry noted that on 19 January 2005 (5 months prior to separation) there was ROM testing which showed flexion of 85 degrees (normal 90) and extension of 10 degrees (normal 30) and no other planes of motion were recorded.  

At the 14 April 2005 VA Compensation and Pension (C&P) evaluation, performed 2 months before separation, the CI reported pain which occurred constantly, lasting all day.  The pain traveled from his lower back to his left foot and toes and was characterized as sharp with his severity at a 4/10.  The CI reported he could function at time of pain with medication.  He reported that a physician recommended bed rest for 14 days.  Functional impairment included inability to perform his military duties.  The CI also reported about a year of lost time from work.  Physical examination showed a normal gait, but the examiner also stated that the CI “requires the use of a cane for walking.”  There was no evidence of radiation of pain on movement, muscle spasm, or tenderness.  Provocative testing for radiculopathy (SLR test) for was positive at 45 degrees on the left.  ROM showed flexion of 45 degrees (normal 90), and combined ROM of 180 degrees (normal 240).  There was major functional impact by weakness, fatigue, lack of endurance, and incoordination after repetitive use.  Neurologic examination showed L4-5 and S-1 neuritis with numbness in the left lateral thigh, left front leg, and foot.  There was weakness in the left leg.  The examiner stated that there was “evidence of intervertebral disk syndrome (IVDS) with chronic and permanent nerve root involvement at L4 with left lateral thigh and left front leg sensory deficit, at L5 with left dorsal foot sensory deficit and at S1 with left lateral leg and left lateral foot sensory deficit.”  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back pain condition 10%, coded 5243 (intervertebral disc syndrome).  The VA rated the low back pain condition 20% coded 5243 (intervertebral disc syndrome), based on the VA C&P examination 2 months before separation, citing limitation of forward flexion.  The VA also rated an associated residual left lower extremity radiculopathy condition 20% coded 8620 (sciatic nerve neuritis), based on the same VA C&P examination, citing sensory deficits and weakness.  The VA examination was the most proximate to separation, was the most comprehensive, and was considered to have the highest probative value for rating at separation.  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 VA examination.  

The Board considered if additional disability rating was justified for peripheral nerve impairment due to radiculopathy.  Radiographic studies supported some level of radicular nerve irritation or involvement, and some service examinations noted some left lower extremity sensory loss.  The VA examination noted both a normal gait and use of a cane; and, in addition to sensory loss noted “weakness in left leg” without specifying either a muscle location or level of motor deficit.  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).”  The sensory deficits were not to the level to impact duty performance.  Therefore the critical decision is whether or not there was a significant motor weakness which would impact military occupation-specific activities.  There was no evidence in this case that motor weakness 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 recommends a disability rating of 20% for the low back pain condition, coded 5243.  

BOARD FINDINGS:  In the matter of the low back pain condition, the Board unanimously recommends a disability rating of 20%, coded 5243 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.  The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Lumbar Disc Herniation L4-5, Degenerative Disc Disease L4-5 and L5/S1	5243	20%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140703, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR COMMANDER, NAVY PERSONNEL COMMAND
	         DEPUTY COMMANDANT, MANPOWER & RESERVE AFFAIRS	
	                          
Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS          

Ref:  (a) DoDI 6040.44
	(b) PDBR ltr dtd 27 Jul 16 ICO XXXXXXXXXXXXXXXXXXXX
	(c) PDBR ltr dtd 27 Jul 16 ICO XXXXXXXXXXXXXXXXXXXX
	(d) PDBR ltr dtd 27 Jul 16 ICO XXXXXXXXXXXXXXXXXXXX
	(e) PDBR ltr dtd 27 Jun 16 ICO XXXXXXXXXXXXXXXXXXXX

1.  Pursuant to reference (a), the recommendations of the Physical Disability Board of Review set forth in references (b) through (e) are approved.

2.  The official records of the following individuals are to be corrected to reflect the stated disposition:

     a. XXXXXXXXXXXXXXXXXXXX, former USN: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge.

     b. XXXXXXXXXXXXXXXXXXXX, former USN: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge.

     c. XXXXXXXXXXXXXXXXXXXX, former USN: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge.
 
     d. XXXXXXXXXXXXXXXXXXXX, former USN: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge.

3.  Please ensure all necessary actions are taken to implement these decisions, including the recoupment of disability severance pay, if warranted, and notification to the subject members once those actions are complete.

	XXXXXXXXXXXXXXXXXXXX
	Assistant General Counsel
	(Manpower & Reserve Affairs)