RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2016-00932
BRANCH OF SERVICE:  Navy	SEPARATION DATE:  20041113

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Damage Controlman, medically separated for “L4-5 and L5-S1 degenerative disk disease [DDD]” with a disability rating of 10%.  

CI CONTENTION:  Review requested of back condition, which has caused multiple negative impacts, and additional conditions not identified by the Medical Evaluation Board (MEB) or the Physical Evaluation Board (PEB).  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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the MEB, but determined by the PEB 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.  The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence relevant to application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards for 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, which operates 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 disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20040303	VARD - 20051125	
Condition	Code	Rating	Condition	Code	Rating	Exam	
L4-5 & L5-S1 DDD	5295	10%	DDD, L-Spine, S/P Laminectomy & Discectomy L4-5 w/Scar	5242	20%	20051013	
L4-5 & L5-S1 Herniated Nucleus Pulposus	Cat II					
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

L4-5 and L5-S1 DDD.  According to the service treatment record and MEB narrative summary (NARSUM), the CI first experienced the onset of low back pain (LBP) in 1998, and an MRI in 2001 revealed “spondylotic disease at the L4-5 and LS-SI levels with a broad-based, circumferential, disk bulge at LS-S1.”  After conservative treatment failed, she underwent surgical fusion of L4-5 and L5-S1 vertebrae in February 2003.  

The 10 December 2003 MEB NARSUM examination, 11 months prior to separation, noted CI complaints of continued LBP while sitting, walking, lying flat, or working on her hands and knees.  Physical examination showed psoas muscle weakness (4/5) bilaterally, with all other strength and neurologic functioning recorded as normal.  Radiographs revealed a well-healing lumbar fusion at L4-5 and L5-S1.  

During a 5 August 2004 orthopedic evaluation, 3 months prior to separation, the CI reported continued radiating LBP that affected daily activities.  The examiner noted a well-healed surgical scar and normal neurologic findings.  Range of motion (ROM) for the lumbar spine (not thoracolumbar) was recorded as flexion to 40 degrees, with pain; and extension, right lateral flexion and right rotation each to 20 degrees.  No normal values were listed and repetition was not noted.  

At the 13 October 2005 VA Compensation and Pension (C&P) examination, 11 months after separation, the CI reported constant radiating LBP rated at 6-7/10, but indicated no related functional impairment (although she later stated she could not push a lawn mower or do gardening).  Physical examination revealed normal posture and gait, as well as normal strength, sensation, and reflexes.  There were muscle spasms but no tenderness, and flexion was to 55 degrees (normal 90) with a combined ROM of 205 degrees (normal 240); painful motion was present.  After repetitive motion, thoracolumbar ROM was limited by pain (major functional impact) and lack of endurance.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, coded 5295 (lumbosacral strain).  The PEB also listed “L4-5 and L5-S1 herniated nucleus pulposus” as a related Category II condition (contributes to the primary unfitting condition), and members agreed that this was the underlying diagnosis for which the surgical fusion procedure was performed.  Thus, it was properly subsumed under the unfitting Category I condition, and not a separately ratable (IAW VASRD §4.14, avoidance of pyramiding).  The VA rated the back condition at 20%, coded 5242 (degenerative arthritis of the spine), based on the C&P examination, citing limitation of motion.  The panel noted the orthopedic evaluation provided lumbar spine ROM values (without specifying methodology, normal values, or repetition), which were not compliant with the VASRD §4.71a (Plate V) requirement for goniometric thoracolumbar ROM testing.  Members adjudged that the C&P examination measurements, which met VASRD guidance, addressed DeLuca criteria, and documented flexion of 55 degrees, were best aligned with the CI’s underlying pathology and carried the highest probative value for rating at separation.  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).  There was no documentation of intervertebral disk syndrome with incapacitating episodes which would provide for a higher rating under that formula.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 20% for the low back condition, coded 5241 (spinal fusion).  

BOARD FINDINGS:  In the matter of the L4-5 and L5-S1 degenerative disk disease, the panel recommends a disability rating of 20%, coded 5241 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 the date of medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
L4-5 and L5-S1 Degenerative Disk Disease	5241	20%	

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		
	(e)	PDBR	ltr dtd	02	Oct	18	ICO	XXXXXXXXXX		

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

a.	XXXXXXXXXX: Entitlement to disability separation pay with a 20 percent disability 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 are complete.