RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02427
BRANCH OF SERVICE:  Navy 	SEPARATION DATE:  20051001 

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an Reserve E6, Information Systems Technician, medically separated for Multiple Degenerative Disc Disease (DDD) with a disability rating of 10%.  

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 - 20050415	VARD - 20070215	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Multiple Degenerative Disc Disease with Questionable Annular Tears	5242 	10%	Degenerative Arthritis with Degenerative Disc Disease, L4-L5	5242 	10%	20070110	
Chronic Lumbago	Cat II					
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Multiple DDD with Questionable Annular Tears.  According to the service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI sustained a back injury in August 2004, while lifting computers during his reserve training.  Radiographic studies showed mild decreased joint space between L4-5, but otherwise no other significant bony changes.  Magnetic resonance imaging (MRI) performed September 2004, was incomplete because the CI became claustrophobic.  However, the findings that were noted were degenerative disc disease from L3 down to S1, with disc bulges and posterior annular tears, and mild foraminal stenosis at L4-5 and S1.  There was no evidence of disc herniation or spinal canal stenosis.  
At the 21 September 2004 physical therapy (PT) clinic appointment, 5 weeks after injury, and 13 months before separation, the CI reported pain in his lower back, and right thigh numbness.  On examination the CI displayed tenderness, and examination maneuvers for radicular signs were negative.  The PT examiner reported trunk flexion reaching the knees which approximates 45‐60 degrees of thoracolumbar flexion.  

The 8 February 2005 MEB NARSUM examination, 8 months prior to separation, the CI reported back pain and thigh paresthesias (abnormal sensation of tingling, numbness, or burning).  These occurred with activities such as baseball, running or physical readiness testing.  The physical examination showed a normal gait, normal reflexes, normal strength, and examination maneuvers for radicular signs were negative.  Lumbar spine ROM was limited as recorded in the chart.  

At the 10 January 2007 VA Compensation and Pension (C&P) evaluation, 15 months after separation, the CI reported sharp constant pain located in the low back, which traveled to his left leg.  The CI displayed a normal gait and spinal contour, no paraspinal muscle spasm, normal reflexes, normal strength, and examination maneuvers for radicular signs were negative.  Thoracolumbar ROM was limited as recorded in the chart.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back condition 10%, coded 5242 (degenerative arthritis of the spine).  The Navy PEB listed the lumbago condition as a related diagnosis (Category II) that contributed to the disability in this case.  The panel agreed that the lumbago was a diagnosis related to the  Cat I unfitting condition and was not a separate condition which could be separately rated IAW §4.14 (avoidance of pyramiding; more than one rating based on the same impairment is prohibited).  The VA also rated the back condition 10% coded 5242, based on the VA C&P examination 15 months after separation, citing forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees.  The panel noted that the limitation of thoracolumbar flexion (25 degrees) reported in the MEB NARSUM suggested consideration of the next higher rating of 40%, however the examiner specified lumbar spine and not the thoracolumbar spine as required in the VASRD.  Panel members agreed that the VA examination, performed 14 months after separation, was more detailed and compliant with VASRD rating guidelines.  Therefore the panel placed greater probative value on the VA examination.  The panel agreed that a 10% rating, but no higher, was justified for limitation of flexion (greater than 60 degrees but not greater than 85 degrees) and combined ROM greater than 120 degrees but not greater than 235 degrees reported on the VA examination.  There was no evidence of intervertebral disc syndrome (IVDS) which resulted in incapacitating episodes requiring physician-prescribed bed rest to warrant consideration of rating under the alternate VASRD formula (for IVDS).  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 impairment (such as weakness) that directly impacted fitness for duty.  The panel 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 panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the low back condition.  

BOARD FINDINGS:  In the matter of the low back condition and IAW VASRD §4.71a, 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 20150615, 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