RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE: PD-2017-03181
BRANCH OF SERVICE: NAVY	SEPARATION DATE: 20080729

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, LCAC Mechanical Systems Maintenance Technician, medically separated for “low back pain” with a disability rating of 10%.

CI CONTENTION:  Review all conditions.  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 - 20080402	VARD - 20080730	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Low Back Pain	5299-5237	10%	Degenerative Disc Disease (DDD) with Intervertebral Disc Syndrome with Osteoarthritic Changes, Lumbar Spine	
5243-5242	
10%	
20080606	
Sacroiliitis, Right	
Cat II					
Lumbar Disk Herniation						
DDD L4/L5 And L5/S1						
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 50%	

ANALYSIS SUMMARY:

Low Back Pain. According to the service treatment record and MEB narrative summary (NARSUM), the CI’s low back pain began in September 2006 after insidious onset with no trauma. An MRI revealed degenerative disc disease (DDD) at L4-L5 and L5-S1, and X-rays in November 2007 confirmed DDD at L4-L5 and L5-S1 with disc herniation and osteoarthritic changes. A MRI of the pelvis on 26 November 2007 showed subtle increased signal activity within the iliac aspect of the right sacroiliac joint, which indicated possible sacroiliitis.

The 4 March 2008 MEB NARSUM examination, 4 months prior to separation, noted CI complaints of dull, right-sided back pain that occasionally radiated down the right leg. Physical examination showed right quadratus and sacroiliac area tenderness, and no leg length discrepancy. The examiner noted lower back flexion was to “mid-calf with pain [greater than 60 degrees], and it was worse with extension.” At the 26 March 2008 MEB physical therapy evaluation, thoracolumbar range of motion (ROM) measurements revealed flexion to 50 degrees (normal 90) with a combined ROM of 185 degrees (normal 240).

During the 6 June 2008 VA Compensation and Pension (C&P) examination, 1 month prior to separation, the CI reported lower back stiffness, weakness, and right-side numbness involving the right leg. Physical examination showed normal posture and gait, and no muscle spasm, radiating pain, abnormal curvature, or ankylosis. There was tenderness over the midline lumbar spine and in the right paraspinous region. Thoracolumbar flexion was to 75 degrees and combined ROM was 175 degrees, with painful motion. There was no fatigue, weakness, lack of endurance, or incoordination after repetitive use. Spinal X-rays revealed no abnormalities.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the low back condition 10%, analogously coded 5299-5237 (lumbosacral strain). The PEB listed sacroiliitis, lumbar disk herniation and DDD at L4/L5 and L5/S1 as related Category II diagnoses that contributed to the disability in this case, and the panel agreed that these conditions could not be separately rated IAW §4.14 (avoidance of pyramiding; more than one rating based on the same impairment is prohibited). The VA also rated the low back pain 10%, but dual coded 5243-5242 (intervertebral disc syndrome-degenerative arthritis of the spine), based on the C&P examination, citing thoracolumbar spine tenderness, and painful, limited motion with flexion to 75 degrees and combined ROM of 175 degrees. Panel members agreed that a 10% rating, but no higher, was justified for limitation of flexion (greater than 60 degrees but not greater than 85 degrees and combined ROM (greater than 120 degrees but not greater than 235 degrees), as reported on the MEB and VA examinations. 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 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 low back pain.

BOARD FINDINGS: In the matter of the low back pain 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:

2	PD-2017-03181

DEPARTMENT OF THE NAVY
SECRETARY OF THE NAVY COUNCIL OF REVIEW BOARDS 720 KENNON STREET SE STE 309
WASHINGTON NAVY YARD, DC 20374-5023

IN   REPLY  REFER  TO,

1850
CORB: 003 20May20

From:

Director, Secretary of the Navy Council of Review Boards 

Subj:  PHYSICAL  DISABILITY BOARD OF REVIEW (PDBR)

Ref:	(a) DoDI 6040.44
(b) PDBR ltr dtd 5 May 19

1.	Pursuant to reference (a), the PDBR reviewed your case and forwarded its recommendation (reference (b)) to the Department of the Navy on 5 Mar 2020 for appropriate  action.

2.	On 20 March 2020, the Assistant Secretary of the Navy (Manpower & Reserve Affairs) accepted the recommendation of the PDBR ofno change to your characterization of separation or disability rating assigned by the Department of the Navy's Physical Evaluation  Board.

3.	The Secretary's decision on your PDBR application is final and is not subject to appeal or additional review by the Board for Correction of Naval Records.

Copy to: PDBR