RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01405
BRANCH OF SERVICE:  navy 	SEPARATION DATE:  20040831

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Armament Weapons Support Equipment Maintenance Manager, medically separated for “sacroiliac joint pain” with a disability rating of 10%.  

CI CONTENTION:  His medical issues have progressively gotten worse.  The VA rated him at 90% as of 12 February 2016.  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 Medical Evaluation Board (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 – 20040511 	VARD - 20050426	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Sacroiliac Joint Pain	5327	10%	Lumbosacral Strain	5237	10%	20041209	
Somatic Dysfunction Lumbar Region	Cat II					
Lumbago	Cat II					
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Sacroiliac Join Pain (SIJ).  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s SIJ pain began in August 2002, following a motor vehicle accident in which he was rear-ended as the restrained driver of a stopped vehicle.  On 12 May 2003, X-rays were normal, but an MRI on 17 June 2003 demonstrated multilevel degenerative disc disease and degenerative joint disease.  While neurological findings were normal, electrodiagnostic testing on 15 July 2003 was consistent with a right lower lumbar radiculopathy.  A discogram (provocative test for nerve root irritation by a disc) on 5 August 2003 was partially concordant for pain at L4-5 and L5-S1, as symptoms were greater on the left during the test, but greater on the right otherwise.  The CI was not a surgical candidate and despite an epidural steroid injection and other non-surgical treatment, he could not return to full duty.  

The 18 March 2004 MEB NARSUM examination, 5 months before separation, documented complaints of constant pain.  The CI could not exercise or perform his ordinance handling duties, but was in an administrative position.  On physical examination, he walked gingerly; however this was 2 days after bilateral SIJ injections.  Neurological findings were normal but there was lumbar tenderness and decreased range of motion (ROM) in all planes secondary to pain.  At the primary care visit for separation screening on 7 July 2004, 2 months prior to separation, the examiner noted tenderness, but testing for nerve root irritation and SIJ pain was negative.  Back ROM was full and neurological findings were normal; gait was not recorded.  

At the 9 December 2004 VA Compensation and Pension (C&P) evaluation, 3 months after separation, the CI complained of daily pain, but denied radicular symptoms.  He also reported incapacitating episodes 3 times over the previous year.  Physical examination showed tenderness, but no muscle spasms and a normal gait.  Back ROM was normal before and after repetition, but there was pain beyond 80 degrees of flexion.  Neurological findings were normal.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the SIJ pain condition 10%, coded 5237 (lumbar spine strain).  The PEB also listed the lumbar region somatic dysfunction and lumbago conditions as related Category II (contribute to the disability but not separately ratable) diagnoses. The impairment from the somatic dysfunction lumbar region, and lumbago were properly subsumed under the overall rating for the sacroiliac joint pain IAW §4.14 (avoidance of pyramiding; more than one rating based on the same impairment is prohibited).  The VA rated the lumbosacral strain condition 10%, coded 5237, based on the C&P evaluation, citing painful motion.  The panel agreed that a 10% rating, but no higher, was justified for limitation of flexion as recorded on the NARSUM examination.  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 concluded there was insufficient cause to recommend a change in the PEB adjudication for the SIJ pain condition.  

BOARD FINDINGS:  In the matter of the SIJ pain condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  There are no other conditions within the panel’s scope of review for consideration.  Therefore, the panel recommends 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 20161012, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs 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:

		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN