RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00043
BRANCH OF SERVICE:  Navy 	SEPARATION DATE:  20080430

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Storekeeper, medically separated for “low back pain” with a disability rating of 20%.  

CI CONTENTION:  “The final diagnosis at the time of the medical board was a degenerative disc with radiculopathy, the only option was to operate and receive an artificial disc or spinal fusion.  At that time, I was told that if I received the operation I would automatically be found unfit for duty.  After 8 years in the Navy, there were no other options in which I could continue my career in the service.  Due to the nature of this injury, it has prevented me from an active lifestyle. I've had to change my job field. Previously I was trained in Logistics and loved it.  Now I am not able to work in such a physically demanding field.”  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 - 20080220	VARD - 20081103	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Low Back Pain	5237	20%	Lumbosacral Spondylosis	5239	10%	20080829	
Mild Degenerative Disc Disease	Cat II					
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Low Back Pain.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s low back pain began in 2003 as a result of a twisting injury.  The condition was managed conservatively until August 2006 when the CI exacerbated the low back pain after lifting her child.  A discogram and discography study in August 2007 showed positive pain response at L5-S1 vertebrae (9/10 intensity, on a scale of 0-10 with 10 being the most pain), posterior leakage at that level, with no morphologic evidence of degenerative disk disease.  Further conservative treatment did not restore the CI to full duty status and although surgery was initially recommended, a second opinion ruled out the CI’s surgical candidacy.  

At the 25 July 2007 orthopedic clinic examination, 9 months prior to separation, the CI complained of pain across her lower back radiating to the buttocks bilaterally.  Physical examination showed the CI had a normal gait with normal spine contour.  She could walk on heels and toes without difficulty.  There were no spasms or tenderness present.  The CI’s neurologic examination was essentially normal.  Range of motion (ROM) measurements of the CI’s thoracolumbar spine were recorded as “normal,” although a slight decrease in ROM in extension (10-20 degrees; normal of 30 degrees) with mild discomfort was noted.  

At the January 2008 MEB examination (recorded on DD Forms 2807 and 2808), 8 months prior to separation, the CI reported chronic lower back pain.  Physical examination referred the reader to the medical record regarding the CI’s spine, however, deep tendon reflexes (DTR) for the CI’s right ankle were recorded and showed a decrease (1 out of 4) with all other lower extremity DTRs 2/4 (normal).  

The 30 November 2007 MEB NARSUM examination, 5 months prior to separation, noted complaints of lower back pain and weakness in the CI’s lower extremities.  Physical examination showed normal heel and toe walk with normal gait and normal spine contour.  No spasms or tenderness were noted.  ROM showed 40 degrees of forward flexion (normal 90) and slightly decreased extension (10-20 degrees) with mild discomfort.  Combined ROM was undetermined as not all planes of ROM were annotated by the examiner.  The CI was neurovascularly intact with normal reflexes (2+ and symmetric) and normal strength (5/5) in all groups of the lower extremities bilaterally.  

At the 29 August 2008 VA Compensation and Pension (C&P) evaluation, performed 4 months after separation, the CI reported intermittent low back pain, occurring three or four times per week and lasting for a day.  The pain radiated to both buttocks and lower extremities. The pain was described as aching and sharp with intensity of 8-9/10.  The CI’s low back pain was spontaneous in nature but could also be exacerbated by lying on her back or with physical activity.  Pain was relieved with rest and narcotic medication, although the CI could function when taking medication.  Physical exam showed a normal gait, normal spine contour with no spasms or tenderness.  ROM measurements demonstrated painful motion with flexion to 85 degrees (normal 90).  Combined ROM was undetermined as not all ROM planes were recorded by the examiner using numerical criteria (provided values would be greater than 120 degrees, but not greater than 235 degrees).  Repetitive ROM testing yielded no increased fatigue, incoordination, or lack of endurance but did reveal pain and weakness as the predominant issues involving the thoracolumbar spine.  Strength, and sensation of the lower extremities were normal with symmetric reflexes.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back pain condition 20%, coded 5237 (lumbosacral strain).  The PEB also listed mild degenerative disc disease as a related Category II condition (a condition that contributed to the primary unfitting condition but was not separately ratable).  The impairment from the mild degenerative disc disease was properly subsumed under the overall rating for the low back pain IAW §4.14 (avoidance of pyramiding; more than one rating based on the same impairment is prohibited).  The VA rated the low back pain condition 10% coded 5239 (spondylolisthesis or segmental instability), based on the VA C&P examination 4 months after separation, citing evidence that the forward flexion of the thoracolumbar spine was not greater than 85 degrees.  

The panel 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 NARSUM examination.  There was no documentation of intervertebral disc syndrome (IVDS) with incapacitating episodes which would provide for a higher rating under that 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 pain condition.  

BOARD FINDINGS:   In the matter of the low back pain 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 20160127, 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:

		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USMC

		
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	     				  Acting