RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02489
BRANCH OF SERVICE:  NAVY 	SEPARATION DATE:  20060503

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Aegis Combat System Computer System Maintenance Technician, medically separated for “L4-L5 lumbar disc herniation, with right-sided radiculopathy,” with a disability rating of 10%.   

CI CONTENTION:  The CI made a contention for the following conditions; back, knees, left shoulder, ankles, nerve damage, and numbness in right lower leg.  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 at the time of separation.  The panel has neither the role nor the authority to compensate for progression or complications of service-connected conditions after separation.  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 - 20060309	VARD - 20080107	
Condition	Code	Rating	Condition	Code	Rating	Exam	
L4-L5 Lumbar Disc Herniation, with Right-Sided Radiculopathy	5243-8720	10%	Residuals, Herniated Disc L4-L5, Post-Op	5243	10%	20071101	
	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

L4-L5 Lumbar Disc Herniation, with Right-Sided Radiculopathy.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent back surgery on 29 June 2005 (L4-L5 hemilaminectory and right-sided discectomy), 10 months prior to separation, for symptoms of back pain and right-sided radiculopathy.  However, the CI continued to experience right lower extremity numbness and occasional stiffness in his back.  

The 26 January 2006 MEB NARSUM orthopedics examination, 3 months prior to separation, noted complaints of low back stiffness and right lower extremity numbness causing dysfunction.  Physical examination showed a normal gait.  The examiner stated that on lumbar range of motion (ROM) the CI had “limited flexion to approximately 60 degrees (no normal value listed).  He has full extension.”  There was normal strength and reflexes in the lower extremities and the CI exhibited no straight leg raising (no radiculopathy).  There was decreased light touch sensation from the lateral leg to the dorsum of the foot in the L5 distribution.  

At the 1 November 2007 VA Compensation and Pension (C&P) evaluation, 18 months after separation, the CI reported that he was diagnosed with herniated disc at L4-L5.  Physical examination showed a slow, guarded gait, favoring the right leg.  There was no evidence of radiating pain on movement, no muscle spasms, and no tenderness.  Straight leg raise tests were negative for radiculopathy and there was no ankylosis of the lumbar spine.  The thoracolumbar spine ROM measurements showed a normal flexion of 90 degrees and a combined ROM of 210 degrees (normal 240).  The examiner stated:  “The joint function of the spine is additionally limited by the following after repetitive use:  pain, fatigue, weakness, lack of endurance, incoordination, and pain has the major functional impact.  The above additionally limit the joint function by 30 degrees.”  There was normal lower leg sensation, muscle strength, and reflexes.  There was no signs of intervertebral disc syndrome with chronic and permanent nerve root involvement, and there was normal curvature of the spine.  Radiographic (X-ray) studies of the spine showed joint narrowing, mild narrowing of the L4-L5 disc space, and no evidence of spondylosis.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, coded 5243-8720 (intervertebral disc syndrome-neuralgia of the sciatic nerve).  The VA rated the back condition 10%, coded 5243 (intervertebral disc syndrome), citing objective evidence has shown painful reduced range of motion.  There was no VA peripheral nerve rating proximate to separation (until 2015 as a not service connected condition, citing no current diagnosed disability).  

In assigning probative value to the MEB orthopedic NARSUM and C&P examinations, the panel noted that review of the STR did not detail any further injury or worsening of the condition prior to separation.  The VA examination’s probative value was judged to be compromised by its remoteness (18 months) from the date of separation.  Therefore, based on all evidence and the associated conclusions just elaborated, panel consensus was that preponderant probative value should be assigned to the MEB orthopedic examination proximate to separation.  

The PEB disability description and coding used clearly indicated their 10% rating was for “mild” sciatic neuropathy (radiculopathy - 8720) due to intervertebral disc syndrome (5243-IVDS).  The CI had paresthesias in his right leg (tingling/numbness) with no motor weakness or reflex deficit.  Given the normal gait and documented sensory deficit noted above, there was insufficient evidence for the next higher 20% rating for analogy to “moderate” incomplete paralysis of the sciatic nerve.  

The panel next deliberated if the CI’s back stiffness and limited motion (disc disorder of lumbar region per the MEB) was unfitting and ratable.  Limited or painful lumbar motion is not included in rating peripheral neuropathy, and the duty limitations from the back stiffness, painful motion, and limited flexion could not be separated from the duty-limiting impairments of the CI’s back surgery peripheral nerve residuals.  The panel therefore adjudged that the CI’s back condition was unfitting and ratable.  

The panel noted the MEB orthopedic examination provided ROM values for the “lumbar” spine which was not the goniometric thoracolumbar ROM specified by the VASRD (§4.71a, Plate V), but the examiner did specify “limited flexion.”  There was sufficient limitation of motion to support a 10% rating, and the panel agreed a 10% rating was justified for the presence of painful and limited motion at the time of separation.  There was no muscle spasm or guarding severe enough to result in an abnormal gait or spinal contour, thus the next higher 20% 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 recommends a disability rating of 10% coded 5243-8720 (sciatica), and an additional 10% disability rating coded 5243 (back pain and stiffness).  

BOARD FINDINGS:  In the matter of the L4-L5 lumbar disc herniation, with right-sided radiculopathy condition, the panel unanimously recommends a disability rating of 10%, coded 5243-8720 IAW VASRD §4.124a, and an additional rating of 10%, coded 5243 IAW VASRD §4.71a.  There are no other conditions within the panel’s scope of review for consideration.  The panel 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	
L4-L5 Lumbar Disc Herniation, with Right-Sided Radiculopathy	Lumbar Disc	5243-8720	10%	
	Radiculopathy	5243	10%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150623, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR DEPUTY COMMANDANT (Manpower and Reserve Affairs)
		   COMMANDER, NAVY PERSONNEL COMMAND	
	                          
Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS          

Ref:  (a) DoDI 6040.44
	(b) PDBR ltr dtd 18 Aug 17 ICO XXXXXXXXXXXXXXXXXXX
	(c) PDBR ltr dtd 18 Aug 17 ICO XXXXXXXXXXXXXXXXXXX
	(d) PDBR ltr dtd 18 Aug 17 ICO XXXXXXXXXXXXXXXXXXX
	(e) PDBR ltr dtd 18 Aug 17 ICO XXXXXXXXXXXXXXXXXXX
	(f) PDBR ltr dtd 18 Aug 17 ICO XXXXXXXXXXXXXXXXXXX
	(g) PDBR ltr dtd 18 Aug 17 ICO XXXXXXXXXXXXXXXXXXX
	(h) PDBR ltr dtd 18 Aug 17 ICO XXXXXXXXXXXXXXXXXXX
	(i) PDBR ltr dtd 18 Aug 17 ICO XXXXXXXXXXXXXXXXXXX
	(j) PDBR ltr dtd 22 Aug 17 ICO XXXXXXXXXXXXXXXXXXX
	(k) PDBR ltr dtd 18 Aug 17 ICO XXXXXXXXXXXXXXXXXXX
	(l) PDBR ltr dtd 18 Aug 17 ICO XXXXXXXXXXXXXXXXXXX
	(m) PDBR ltr dtd 18 Aug 17 ICO XXXXXXXXXXXXXXXXXXX
	(n) PDBR ltr dtd 21 Aug 17 ICO XXXXXXXXXXXXXXXXXXX
	(o) PDBR ltr dtd 18 Aug 17 ICO XXXXXXXXXXXXXXXXXXX

1.  Pursuant to reference (a), the recommendations of the Physical Disability Board of Review set forth in references (b) through (o) are approved.  The official records of the following individuals are to be corrected as follows:

     a. XXXXXXXXXXXXXXXXXXX, former USN: Placement on the Permanent Disability Retired List with a 30 percent rating (increased from 20 percent) effective date of discharge.

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

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

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

     e. XXXXXXXXXXXXXXXXXXX, former USMC: Placement on the Permanent Disability Retired List with a 30 percent rating (increased from 10 percent) effective date of discharge.

     f. XXXXXXXXXXXXXXXXXXX, former USMC: Entitlement to disability separation pay with a 20 percent disability rating (increased from 0 percent) effective date of discharge. 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS

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

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

     i. XXXXXXXXXXXXXXXXXXX, former USMC: Placement on the Permanent Disability Retired List with a 30 percent rating (increased from 20 percent) effective date of discharge.

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

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

     l. XXXXXXXXXXXXXXXXXXX, former USMC: Entitlement to disability separation pay with a 10 percent disability rating (increased from 0 percent) effective date of discharge. 

     m. XXXXXXXXXXXXXXXXXXX, former USMC: Entitlement to disability separation pay with a 10 percent disability rating (increased from 0 percent) effective date of discharge. 

     n. XXXXXXXXXXXXXXXXXXX, former USN: Placement on the Permanent Disability Retired List with a 30 percent rating (increased from 10 percent) effective date of discharge.
     
3.  Please take action to implement these decisions and provide notification to the above individuals once those actions are complete.

	XXXXXXXXXXXXXXXXXXX
	Acting