RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME: XXXXXXXXXXXXXXXXXX	CASE: PD-2017-04161
BRANCH OF SERVICE:  NAVY	SEPARATION DATE: 20051209

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Utilitiesman, medically separated for “low back pain” with a disability rating of 20%.

CI CONTENTION: No specific contention was 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 - 20050817	VARD - 20060524	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Low Back Pain	5237	20%	Lumbar Strain	5237	40%	20060216	
Tethered Cord Release and Sectioning of
the Filum Terminale	Cat II					
COMBINED RATING: 20%	COMBINED RATING OF ALL VA CONDITIONS: 80%	

ANALYSIS SUMMARY:

Low Back Pain. According to the service treatment record and MEB narrative summary (NARSUM), the CI’s back condition began in 2002 after a vehicle accident. He suffered another vehicle accident in June 2003. In January 2004 he was diagnosed with tethered cord syndrome and underwent tethered cord surgery in April 2004. This was complicated by a wound infection and required incision and drainage. The condition worsened in January 2005 with prolonged standing and sitting. A lumbar MRI showed degenerative disc disease at L5-S1 with an annular tear, but no herniation was present. Further surgery was offered, but the CI opted for conservative treatment.

The 17 April 2005 MEB NARSUM examination, 8 months prior to separation, noted complaints of severe low back pain with standing or sitting too long, and left leg numbness. Physical examination showed “diminished range of motion [ROM], particulary with extension,” but the CI was able to heel and toe walk. Straight leg raise testing was negative, lower extremity motor strength and reflexes were normal, but sensation was diminished in the entire left leg.

During the 12 August 2005 MEB examination (recorded on DD Forms 2807-1 and 2808), 4 months prior to separation, the CI reported heavy pressure and burning from the center of the back to the waist from sitting, standing or driving too long. Physical examination showed flexion limited to 45 degrees (normal 90), decreased sensation in the left leg and 4/5 weakness with dorsiflexion and plantar flexion of the left ankle.

At the 16 February 2006 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported back pain with radiation of pain into the left leg. He denied flare-ups, but endorsed urinary incontinence. Physical examination showed good heel and toe rising. ROM testing showed 30 degrees of flexion and 70 degrees of combined ROM. There was pain with motion and increased pain after repetitive motion, but no fatigability, weakness, lack of endurance, or incoordination. Although there were no reflex or motor defects, straight leg raise testing was positive and sensation was decreased in the L5 nerve root distribution on the right.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the back condition 20%, analogously coded 5299-5237 (lumbosacral strain). It is first clarified that the PEB’s Category II diagnosis (tethered cord release and sectioning of the filum terminale) is intrinsic to the rated condition and a separate rating cannot be supported without pyramiding (VASRD §4.14); thus, it is appropriately subsumed under the rating for the back. The VA rated the back condition 40%, coded 5237, based on the C&P examination, citing forward flexion of the thoracolumbar spine of 30 degrees or less.

Panel members first considered the somewhat disparate ROM evaluations and agreed the pre- separation MEB examination held more probative value than the post-separation VA examination because there was no interim injury or trauma to explain the post-separation worsening of forward flexion. A subsequent VA ROM evaluation in October 2010 showed forward flexion of 45 degrees (consistent with the MEB ROM study). Therefore, 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 MEB examination. There was no evidence of intervertebral disc syndrome which resulted in incapacitating episodes requiring physician- prescribed bed rest to warrant consideration of rating under that alternate VASRD formula. 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 back condition.

BOARD FINDINGS: In the matter of the low back 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:

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

IN REPLY REI'ER TO,
1850
CORB: 003
10 Sep 20

From: Director, Secretary of the Navy Council of Review Boards To:

Subj: PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) Ref:	(a) DoDI 6040.44
1.	Pursuant to reference (a), the PDBR reviewed your case and forwarded its recommendation to the Department of the Navy on 13 Aug 2020 for appropriate action.

2.	On 27 August 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.