RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00164
BRANCH OF SERVICE:  Navy 	SEPARATION DATE:  20060703

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a Navy active duty E3, Service and Supply Handler, medically separated for “continued lumbar back pain after L5-S1 decompression/discectomy” with a disability rating of 20%.  

CI CONTENTION:  “I have now had three (3) back surgeries and I have only seen the review board twice.  My conditions make it very difficult to gain and keep employment.”  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 - 20060426	VARD - 20071218	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Continued Lumbar Back Pain after L5-S1 Decompression/Discectomy	5237	20%	Intervertebral Disc Syndrome, Lumbar Spine, Status Post Lumbar Laminectomy and Discectomy with Residual Disfiguring Surgical Scar	5243	20%	20071121	
	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 underwent back surgery with discectomy in December 2005 for a herniated disc with radiation to his right lower extremity.  Following surgery further treatment did not result in improvement sufficient to allow unrestricted duty.  

The 13 February 2006 MEB NARSUM examination, 5 months prior to separation, noted that the CI’s right leg pain was approximately 80% resolved by the surgery, but he continued to have back pain which had intensified.  He was able to do gentle walking and swimming but was unable to run and found stairwells and ladderwells to be painful.  Physical examination showed a well healed surgical scar and normal gait.  His sacroiliac joints were nontender.  Lower extremity strength, sensation, and reflexes were normal.  Straight leg raise (SLR) testing was negative for radiating symptoms.  The 10 April 2006 MEB physical on DD Form 2808 documented muscle spasm of the right flank under the spine examination.  

At the 21 November 2007 VA Compensation and Pension (C&P) evaluation, performed 16 months after separation, the CI reported constant pain associated with stiffness and weakness, with radiation to the right lower extremity to a lesser extent than previously.  He reported the pain was 8/10 in severity.  He denied any periods of physician-prescribed bed rest during the previous 12 months.  Physical exam showed limited and painful motion in all directions, with evidence of paraspinal muscle spasm and tenderness to palpation at L3-4, L4-5, and L5-S1.  Range of motion (ROM) measurement showed forward flexion to 45 degrees (normal 90) and combined ROM of 160 degrees (normal 240) with no change following repetition.  There was no weakness noted, and gait and contour were normal.  SLR testing produced radiating pain in the right leg below the knee.  The examiner noted evidence of intervertebral disc syndrome at the L4-5 and L5-S1 levels in the sciatic nerve distribution, and decreased sensation in the sciatic nerve distribution in the right lower extremity.  Motor strength in the lower extremities was 5/5 (normal) and there was no evidence of muscle atrophy.  

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 or cervical strain).  The VA rated the low back pain condition 20% coded 5243 (intervertebral disc syndrome), based on the VA C&P examination 16 months after separation, citing forward flexion of the thoracolumbar spine of 45 degrees.  

None of the examinations in evidence showed ankylosis of the entire thoracolumbar spine, or forward flexion of the thoracolumbar spine being limited to 30 degrees or less to support any rating higher than the 20% awarded by the PEB.  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 that condition.  The panel concluded there was no evidence to support a rating higher than that adjudicated by the PEB.  

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 20160326, 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