RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:XXXXXXXXXXXXXXXXX	CASE:  PD-2017	-0438	4
BRANCH OF SERVICE:  NAVY	SEPARATION DATE: 20091007
SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6, Cryptologic Technician, medically separated for “lumbago” with a disability rating of 20%.
CI CONTENTION: “I was not given the option to request retirement and have had my condition worsen.” 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 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 - 20090805	VARD - 20100302	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Lumbago	5237	20%	Lumbar Facet Arthropathy and Degenerative Disc Disease with Radiculopathy	5242	20%	20090314	
Sciatica	Cat II					
COMBINED RATING: 20%	COMBINED RATING OF ALL VA CONDITIONS: 40%	

ANALYSIS SUMMARY:

Lumbago. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI developed low back pain with pregnancy in 2007. A radicular component, with the probative imaging evidence, is addressed separately below and did not result in surgery. Provider entries in the STR documented grossly normal or nonspecifically limited range of motion (ROM), and none suggested the presence of severe limitation. There was ample documentation of a normal gait and spinal contour.

At the 14 March 2009 VA Compensation and Pension (C&P) orthopedic examination, 7 months before separation, the CI reported severe and constant low back pain aggravated by prolonged sitting and standing, twisting, bending and jogging. The examiner documented a quarter-mile walking tolerance and the absence of any incapacitating episodes. The physical examination recorded normal gait and spinal contour without spasm, but there was tenderness. Thoracolumbar flexion was limited to 60 degrees (normal 90) and combined ROM was 145 degrees (normal 240).

The 26 June 2009 MEB NARSUM examination, 3 months prior to separation, noted the CI’s complaint of persistent low back pain, rated at 7/10, which interfered with running and prolonged sitting, standing and walking. The examiner recorded normal spinal contour without note of gait disturbance, but there was tenderness and “mild” spasm. Measured ROM showed flexion limited to 40 degrees, extension to 5 degrees (normal 30), and right lateral flexion to 30 degrees (normal) and left to 20 degrees; rotational measurements were not included.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the back condition 20%, coded 5237 (lumbosacral strain). The VA also rated the condition 20%, coded 5242 (degenerative arthritis of the spine), based on the C&P examination, citing the applicable VASRD §4.71a spine criterion for thoracolumbar flexion. Panel members 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 in the VA C&P and NARSUM examinations. 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 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.

Sciatica. The CI also suffered intermittent pain radiating to the left lower extremity (LLE). Serial MRIs demonstrated degenerative disc disease at L4/5 and L5/S1 with patent neural foramina at all levels. There was inconsistent documentation of associated LLE sensory complaints, and multiple treatment notes documented that the CI denied subjective leg weakness. There were 17 STR provider entries, including specialists and consultants, that recorded normal objective neurological findings (5/5 strength, symmetric reflexes and intact sensory). There was one physical therapy note that recorded 4-4+/5 motor strength of all groups bilaterally (including levels with normal findings by MRI).

The pre-separation VA C&P orthopedic examination recorded 4/5 motor strength for dorsiflexion of the left ankle and great toe (L4-S1). Reflexes and sensory findings were normal, and a general C&P examination by the same examiner on the day before recorded 5/5 lower extremity motor strength. The NARSUM recorded 5/5 strength for all lower extremity groups on the right (all spinal levels tested), but stated that they were “all 4+/5 on the left and seem guarded.” Sensory testing was normal, but reflexes were noted to be symmetrically unobtainable.

The panel directed attention to its recommendations based on the above evidence. “Sciatica” was adjudicated by the PEB as Category II (related condition that contributes to the unfitting condition). Therefore, the panel’s first charge was to assess whether the sciatica (radiating pain to the LLE) could be justified as separately unfitting for additional service rating. Category II conditions are reasonably justified as separately unfitting unless a preponderance of evidence indicates that they would not cause the member to be referred into the Disability Evaluation System or be found unfit because of physical disability. Panel members noted that the pain component of a spinal radiculopathy is subsumed under the VASRD §4.71a general spine rating criteria, which specifically states “with or without symptoms such as pain (whether or not it radiates).” This rationale was cited in the VA rating decision for subsuming the radiculopathy with the spine rating, and there was no objective sensory component either impacting fitness or subject to VASRD rating. The key decision for the panel, therefore, was whether the C&P and NARSUM findings for mild motor impairment were probative enough and of sufficient functional consequence to merit separate rating under the above standard. There was no evidence for functional impairment specifically due to the neuropathy (excluding the subsumed radiating pain) in the commander’s non-medical assessment, limited duty boards, or any STR provider entries (to include the C&P and NARSUM). Panel members concluded that the preponderance of evidence compellingly indicated that there was no motor impairment as a consistent baseline finding, and this was clinically aligned with the imaging evidence. The panel further agreed that

the motor findings (weakness) in evidence were, more likely than not, attributable to subsumed pain and guarding rather than to nerve pathology; and, even if intermittent mild L5/S1 weakness was conceded, there was no link to any unfitting functional impairment (gait and balance was normal). Therefore, after due deliberation and with application of the above preponderance standard for Category II recommendations, the panel concluded there was insufficient justification for recommending the sciatica as a separately ratable condition apart from that already subsumed in the PEB’s 20% spine rating.

BOARD FINDINGS: In the matter of the back condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication. In the matter of the contended sciatica, the panel agrees it cannot recommend it for additional disability rating. 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 TIIE NAVY COUNCIL OF REVIEW BOARDS 720 KE?mON STREET SE STE 309
WASHINGTON NAVY YARD, DC 20374-5023

IN RE PLY REFER TO ,
1850
CORB: 003
10 Sep20

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.