;:J 1 15 2018

MEMORANDUM FOR DEPUTY COMMANDANT (Manpower and Reserve A£fairs) COMMANDER, NAVY PERSONNEL COMMAND
Subj:		PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS Ref:	(a) DoDi 6040.44
(j)	PDBR ltr dtd 16 Oct 18 ICO XXXXXXXXXX

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

j. XXXXXXXXXX, former USN: 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 actions are complete.

RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-00213
BRANCH OF SERVICE:  Navy 	SEPARATION DATE:  20041213

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Surface HF Communications System Maintenance Technician, medically separated for “chronic low back pain” 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 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 - 20040903	VARD - 20050602	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5237	10%	Lumbar Disc Bulge	5237-5243	20%	20040930	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Chronic Low Back Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s back condition began in December 2002 after lifting antennas.  X-rays were normal on 27 December 2002, but an MRI on 3 February 2003, ordered for severe back for 2 months, showed disc bulging at L4-5 that caused moderate to severe right sided central spinal canal narrowing and narrowing of the right neural foramen, and mild L5-S1 bulging.  There was no definitive evidence of neural impingement from either disc bulge.  Multiple sessions of physical therapy provided no relief nor did nonsteroidal anti-inflammatory drugs.  The CI was not a surgical candidate.  On 25 June 2004, the CI had an epidural steroid injection without relief of  pain.  Thereafter, he received toradol (an opioid-like medication) orally and by injection along with oral muscle relaxers.   

The 7 July 2004 MEB NARSUM examination, 5 months prior to separation, noted complaints of chronic subjective low back pain without radiation to the legs.  Physical examination showed no tenderness in the spine or in the paraspinal lumbar area.  Straight leg raise testing (to determine nerve root irritation) was negative and motor strength, reflexes and sensation were normal.  At the 25 July 2004 MEB examination (recorded on DD Forms 2807-1 and 2808), 5 months prior to separation, the CI reported low back pain.  Physical examination showed subjective pain without tenderness in L4-S1, more toward the left side. 

At the 30 September 2004 VA Compensation and Pension (C&P) examination, 2 months before separation, the CI reported back pain with a severity of 4/10 (10 being the worst pain), which was aggravated by lifting, walking, prolonged sitting, and running.  The pain radiated into his left buttock and leg.  He could still do his “job” and there were no flares due to pain, fatigue, weakness or lack of endurance after repetitive use.  Physical examination showed a normal gait and spinal curvature, but there were spasms.  However, there were no neurological changes.  Range of motion (ROM) measurements showed flexion of 60 degrees (normal 90) and combined ROM of 210 degrees (normal 240).  There was pain in all planes of movement except for left and right lateral flexion.  

Electrodiagnostic studies on 2 November 2004 of the lower extremities were normal.  The 3 November 2004 chiropractic examination, 1 month prior to separation, showed flexion of 70 degrees with pain and 10 degrees of extension (normal 30) with pain.  There was also tenderness.  However, at the 6 December 2004 chiropractic examination, 7 days before separation, the CI reported subjective improvement of 30% and examination showed a full ROM without tenderness.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, coded 5237 (lumbosacral strain).  The VA rated the back condition 20%, dual coded 5237-5243 (lumbosacral strain-intervertebral disc syndrome), based on the C&P examination, citing forward flexion of 0-60 degrees with pain and spasm.

The panel considered the somewhat disparate examinations and agreed the pre-separation VA C&P examination held the most probative value of all pre-separation examinations because it was more comprehensive and included a complete goniometric ROM evaluation.  The panel agreed 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 VA examination.  There was no documentation of intervertebral disc syndrome with incapacitating episodes which would provide for a higher rating under that formula.  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 5237.  

BOARD FINDINGS:  In the matter of the back condition, the panel recommends a disability rating of 20%, coded 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 the date of medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Low Back Pain	5237	20%	
The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20161112, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record