RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01738
BRANCH OF SERVICE:  Navy                                                                   SEPARATION DATE:  20061101

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a Reserve E6, Boatswain Mate, medically separated for “lumbago” with a disability rating of 20%.  

CI CONTENTION:  “Review all conditions.”  The complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The panel’s scope of review is defined in DoDI 6040.44.  It is limited to review of disability ratings assigned 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 or non-compensable.  Any conditions outside the panel’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 panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The panel’s assessment of the PEB rating determination 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(s) at the time of separation.  The panel 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 panel 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 - 20061018	VARD - 20131021	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Lumbago	8799-8720	20%	Lumbar DDD with IVDS	5243	20%	20131015	
Degenerative Disk Disease	Cat II	Radiculopathy, RLE, DDD with IVDS	8726	20%		
Chronic Gluteal Musculoskeletal Strain						
Borderline Stenosis						
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Lumbago.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s back condition began on 28 November 2003 after being thrown up in the air while on a patrol boat and landed impacting his back and right  gluteal muscles area.  Treatment consisted of a steroid injection, a narcotic combination, nonsteroidal anti-inflammatory drugs, muscle relaxers, and a back brace.  By 4 December 2003 the CI reported improvement and pain down to a “3” (10 being the worst pain).  On 10 January 2004 he reported “constant right hip pain” “8” aggravated by boat duties, which was assessed as right SI (sacroiliac) joint sprain 3 days later after X-rays demonstrated an L4-limbus vertebra (marginal interosseous herniation of the nucleus pulposus often confused with a fracture) , but was otherwise okay and without any fractures.  In August 2004 the CI complained of pain to his right hip with certain movements the pain shot down to his right lower buttocks area.  Forward flexion was limited to about 70 degrees.  He received a cortisone shot to the right gluteal region, which helped for only 2 days.  In March 2006 sacroiliac X-rays revealed no abnormalities and lumbar spine X-rays were negative as were X-rays of the hips bilaterally.  

A 16 May 2006 physical therapy examination, 11 months prior to separation, noted pain in right hip and buttock area.  X-rays were reported to be within normal limits.  The CI had an antalgic gait with ambulation in his right lower extremity and weakness in the gluteus medius during standing.  The range of motion (ROM) for flexion was 25 degrees (normal 90) and extension 0 degrees.  After multiple physical therapy sessions, the ROMs for flexion and extension were unchanged by 16 June 2006, 10 months prior to separation.  Right hip extension strength was 3+/5 and right knee flexion strength was 4-/5.  Magnetic resonance imaging dated 27 June 2006 demonstrated borderline stenosis of the spinal canal, multiple degenerative disks without herniation or extrusion.  

The 17 July 2006 MEB NARSUM examination, 9 months prior to separation, noted complaints of recurrent and worsening lumbar and gluteal muscle pain over the prior 2½ to 3 years despite extensive activity modification, physical therapy, medication, and steroid injections.  The CI stated the pain was mainly localized along the anterior/superior iliac spin down through the lumbosacral area.  He denied any radiating pain to his lower extremity.  The physical examination showed an antalgic gait and an inability to stand straight up.  He leaned significantly to his left side to place most of his weight on his left.  The CI was able to perform a slow heel and toe and had a negative straight leg raise (SLR) (to determine nerve root irritation) bilaterally.  He had significant tenderness along the paravertebral muscles of the lumbar spine and presacral area.  There was minimal tenderness to resisted forward flex of the hip and no tenderness along the greater trochanter area.  There was no recorded lumbar ROM.    

There was no VA examination in evidence proximate to separation.

The panel directed attention to its rating recommendation based on the above evidence.  The Navy PEB rated the lumbago condition 20%, 8799-8720 (sciatic nerve neuralgia).  The PEB also listed degenerative disk disease, chronic gluteal musculoskeletal strain and borderline stenosis as related Category II conditions (conditions that contributed to the primary unfitting condition, but were not separately ratable).  The impairment from the degenerative disk disease, chronic gluteal musculoskeletal strain and borderline stenosis was properly subsumed under the overall rating for the Category I unfitting condition IAW §4.14 (avoidance of pyramiding) where more than one rating based on the same impairment is prohibited).  

Panel members had a detailed discussion related to the flexion measurements at physical therapy examinations.  While the physical therapy sessions were to provide treatment for the hip, nevertheless, flexion was reported at 25 degrees.  However, that appeared to reflect lumbar flexion rather than thoracolumbar flexion, which is the standard according to the VASRD General Rating Formula for Diseases and Injuries of the Spine Note (2).  The PEB disability tracking system (JDETS) document was annotated that the 25 degrees flexion was a lumbosacral measurement, which 60 degrees is normal for isolated lumbar flexion.  When combined with a normal thoracic ROM, this would represent approximately 55 degrees of thoracolumbar flexion correlating with a 20% rating using the current VASRD standard.  Therefore, panel agreed that a 20% rating, but no higher was justified; however, PDBR policy is not to change the code used by the PEB if the rating does not change.  Therefore, although a spine code 5243 (intervertebral disc syndrome) more accurately reflects the CI’s overall disability, which included gluteal muscle involvement that has its origin from the outer surface of the ilium, sacrum and coccyx as well as degenerative disc disease and spinal stenosis, the PEB analogous code 8799-8720 sciatic nerve will be continued.  There was no documentation of the intervertebral disc syndrome (IVDS) with incapacitating episodes which would provide for a higher rating under that formula (for IVDS).

After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the lumbago condition.  

BOARD FINDINGS:  In the matter of the lumbago condition and IAW VASRD §4.124a, the panel unanimously recommends no change in the PEB adjudication.  There are no other conditions within the panel’s scope of review for consideration.   The panel, therefore, recommends that there be no modification or re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150628, 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

      In accordance with reference (a), I have reviewed the cases listed below and 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 USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN

		
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	     				  Acting