RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00454
BRANCH OF SERVICE:  NAVY 	SEPARATION DATE:  20060907

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Aviation Machinists Mate, medically separated for “chronic low back pain syndrome” with a disability rating of 10%.   

CI CONTENTION:  No specific contention made.  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 - 20060511	VARD - 19990203	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain…	5299-5237	10%	Low Back Pain…	5292-5295	10%	19980413	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain.  According to the service treatment record and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s LPB began as early as 1997 after lifting.  Radiographic studies in April 2005 showed degenerative disc disease (DDD) with bulging intervertebral discs at L4-L5 and L5-S1.  Evaluation by neurosurgery recommended non-surgical treatment.  At a 12 July 2005 neurosurgery examination, 14 months prior to separation, the CI noted increased flexibility and improvement in his back pain symptoms with medication and resolution of his leg symptoms.  Physical examination showed a slight decrease of extension of the lumbar spine, but flexion was 40 degrees to 45 degrees without limitation or spasm.  

The 10 February 2006 MEB NARSUM examination, 7 months prior to separation, recorded complaints of back pain that prevented the CI from running, sitting for longer than 30 minutes, standing greater than 20 minutes, and lifting more than 30 pounds  He also noted episodes of pain radiating down the posterior aspect of his left leg.  Physical examination showed a normal gait and no lateral curvature of the spine (scoliosis).  The lower back was not tender, and range of motion (ROM) was recorded with flexion described as “fingertip to knees” (roughly equivalent of 45-60 degrees; normal is 90 degrees), extension 30 degrees (normal), and lateral bending 45 degrees (normal 30) bilaterally, with no description of rotation ROM.  There was no proximate VA Compensation and Pension (C&P) evaluation, with a previous examination having been done 8 years prior to separation and the following one performed 10 years after separation.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back pain condition 10%, coded 5299-5237 (analogous to lumbosacral strain).  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) as reported on the NARSUM examination.  The panel noted that while the ROM at the NARSUM were not goniometric, the description of the fingers reaching the knees were sufficiently specific and detailed to conclude the limitation of motion did not approach the 30 degrees of limitation (out of 90 degrees) required to support a 40% rating.  There was no documentation of intervertebral disc syndrome with incapacitating episodes which would provide for a higher rating under that formula.  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.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 20% for the chronic low back pain condition, coded 5299-5237.  

BOARD FINDINGS:  In the matter of the chronic low back pain, the panel unanimously recommends a disability rating of 20%, coded 5299-5237 IAW VASRD §4.71a.  There are no other conditions within the panel’s scope of review for consideration.  

The panel recommends the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Low Back Pain 	5299-5236	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160614, w/atchs
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 12 Feb 18 ICO XXXXXXXXXXXXXXXXXX 
	(c) PDBR ltr dtd 17 Feb 18 ICO XXXXXXXXXXXXXXXXXX
	(d) PDBR ltr dtd 18 Feb 18 ICO XXXXXXXXXXXXXXXXXX
	(e) PDBR ltr dtd 12 Feb 18 ICO XXXXXXXXXXXXXXXXXX
	(f) PDBR ltr dtd 17 Feb 18 ICO XXXXXXXXXXXXXXXXXX
	(g) PDBR ltr dtd 17 Feb 18 ICO XXXXXXXXXXXXXXXXXX    
	(h) PDBR ltr dtd 17 Feb 18 ICO XXXXXXXXXXXXXXXXXX
	(i) PDBR ltr dtd 12 Feb 18 ICO XXXXXXXXXXXXXXXXXX

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

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

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

     c. XXXXXXXXXXXXXXXXXX, former USMC: Placement on the Permanent Disability Retired List with a 30 percent rating (increased from 0 percent) effective date of discharge.     

     d. XXXXXXXXXXXXXXXXXX, former USN: Placement on the Permanent Disability Retired List with a 40 percent rating (increased from 20 percent) effective date of discharge.   

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

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

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

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS

     e. XXXXXXXXXXXXXXXXXX, former USN: Placement on the Temporary Disability Retired List at time of discharge for six months with a 50 percent rating followed by a permanent rating of 10 percent with entitlement to disability severance pay. 
     
3.  Please take action to implement these decisions and provide notification to the above individuals once those actions are complete.