RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXXXXXXXXXX	CASE: PD-2017-05430
BRANCH OF SERVICE: NAVY	SEPARATION DATE: 20080418

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Machinist Mate, medically separated for the overall effect (OE) of “low back pain (LBP),” “right L5 spondylolysis of the left pars, without evidence of spondylolisthesis,” “low grade squamous intraepithelial lesion (LGSIL),” “hematuria possible chronic glomerulonephritis” and “patellofemoral syndrome” with a disability rating of 0%.

CI CONTENTION: Review of all conditions requested. 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 - 20071018	VARD - 20090508	
Condition	Code	Rating	Condition	Code	Rating	Exam	
LBP	

Overall Effect	

0%	
Intervertebral Disc Syndrome (IVDS)	
5242	
20%	

20081010	
Right L5 Spondylolysis of the Left Pars, without Evidence of Spondylolisthesis							
LGSIL			No VA Placement		
Hematuria Possible Chronic Glomerulonephritis			No VA Placement		
Patellofemoral Syndrome			Right Knee	5242	10%		
			Left Knee Patellofemoral Syndrome	5257-
5024	10%		
Transaminase Elevation	Cat III	Liver	7399-
4343	10%		
Obesity	Cat IV	No VA Placement		
COMBINED RATING: 0%	COMBINED RATING OF ALL VA CONDITIONS: 80%	

ANALYSIS SUMMARY:

LBP, Right L5 Spondylolysis [sclerosis] of the Left Pars…, LGSIL, Hematuria…, and Patellofemoral Syndrome. The PEB combined these five conditions and determined they were unfitting based on OE (DoDI 1332.38 E3.P3.4.4.). In OE cases each condition has been determined by the PEB to be separately not unfit, but the OE considered together creates a condition of unfitness. The

panel’s initial charge in this case was therefore directed at determining if combining conditions under OE was justified in lieu of separate ratings. When considering a separate rating for each OE condition, the panel considers each condition to be separately not unfit unless a preponderance of evidence shows the condition to be unfitting. The panel first considered whether there was preponderance of evidence that each of the conditions remained separately unfitting, having been de-coupled from the PEB’s OE adjudication.

The back condition was noted on two periods of limited duty (LIMDU) and the CI was referred to the PEB when her back failed to improve sufficiently to return to unrestricted duty by the end of the second LIMDU. Physical limitations listed were for the CI to run at her own pace and distance and not to perform push-ups. The non-medical assessments (NMA) in record did not specifically identify any of the CI’s medical conditions. The MEB sports medicine addendum determined the CI was unfit for shipboard duty and unable to run or perform push-ups due to chronic LBP. The MEB narrative summary (NARSUM) noted a chief complaint of LBP and that the CI was unable to perform physical training. The MEB NARSUM recommended physical limitations of no ship or aircrew duty, deployment, lifting, push/pull-ups, and no running. The patellofemoral syndrome was not listed on the first LIMDU, but the 31 July 2006 MEB sports medicine addendum referred the CI to the PEB due to back and knee pain which prevented running. However by the second period of LIMDU, the knee condition had improved and was not listed on the final LIMDU or determined to fail retention standards. Neither of the LGSIL or hematuria conditions was noted on any LIMDU or implicated by the commander’s statement and neither failed retention standards. Based on the evidence above, the panel concluded there was a preponderance of evidence that the low back condition was unfitting proximate to separation. However, there was not a preponderance of evidence that any of the other conditions were separately unfitting at separation. The rating evidence for the back condition is considered separately below

According to the service treatment record (STR) and MEB NARSUM, the CI reported her intermittent back pain began in December 2001 when she fell down a ladder well and caught her right leg on a hand railing. In February 2006, the CI’s LBP was exacerbated during physical training. Lumbar spine imaging (X-rays and CT scan) showed normal alignment of the spine with a right pars interarticularis defect (spondylolysis - loss of connection between two vertebrae due to congenital abnormality or fracture) not associated with spondylolisthesis (movement of one vertebra on another), or central spinal canal or neuroforaminal (area through which the spinal nerves exit) stenosis. Lumbar spine MRI on 13 August 2006 did not show any spondylolisthesis of the L5 vertebrae. There was also ligament hypertrophy (degenerative change) at this level.

At a 9 November 2006 sports medicine examination, 17 months prior to separation, the CI reported a 5 year history of LBP greater on the right. She reported she was able to work but had to limit participation in sporting events due to pain. On physical examination back flexion was 90 degrees (normal) with a combined range of motion (ROM) of at least 145 degrees (normal 240), with pain on flexion to extension. The assessment was lumbar spondylosis and continued conservative treatment was recommended. At a LIMDU re-evaluation on 19 December 2006, the CI expressed a strong desire to remain in the Navy. At a LIMDU re-evaluation on 8 March 2007, the CI continued to report moderate back pain graded 5/10.

The 20 March 2007 MEB NARSUM examination, 13 months prior to separation, noted complaints of mid lower back pain, radiating down the left leg. The CI was unable to lift heavy objects or participate in physical training without worsening her pain. She was doing well on shore duty performing administrative duties but was unable to return to sea duty in her Rating. No physical examination was performed other than vital signs, height and weight.

At the 3 April 2007 MEB sports medicine examination, 12 months prior to separation, the CI reported LBP. The MEB examiner noted the CI was unable to run or perform push-ups due to ongoing back pain. She had recently completed her second period of LIMDU with minimal

improvement. Physical examination showed a normal gait and normal lower extremity strength. Back ROM was flexion of 90 degrees and combined ROM of 220. No surgery was recommended by orthopedics. A bone scan was performed to assess the acuteness of the right L5 pars defect and was normal without evidence of a reactive bone abnormality of the lumbosacral spine.

The NMA dated 4 April 2007, 12 months prior to separation, noted the CI desired to remain in the military and she was a highly motivated individual and valuable asset to the Navy. The NMA dated 18 June 2007, 10 months prior to separation, noted the CI desired to stay in the military, but was limited in performing her duties due to numerous medical problems. She had limited success in meeting Navy physical standards and was at risk of an administrative separation within the next year. At the 4 October 2007 physical therapy examination for ROM, 6 months prior to separation, the CI reported back pain graded 4/10. Trunk flexion was 15 degrees with combined ROM of 140 degrees, limited by pain in all planes of motion.

At the 10 October 2008 VA Compensation and Pension (C&P) examination, 6 months after separation the CI reported constant back pain the radiated up her back and down her legs. She reported medication was beneficial and that at the time of pain she could function with medication. The CI reported 3 days of incapacitation in the last 12 months. Physical examination showed an antalgic gait and guarded posture. There were normal spinal curvatures and no evidence of radiating pain on movement. There was lower lumbar muscle spasm and tenderness of the total back. Straight leg raise testing to elicit radicular symptoms was negative bilaterally. Thoracolumbar ROM was flexion of 35 degrees with combined ROM of 80 degrees. No painful motion was noted and the joint function of the spine was not additionally limited by pain, fatigue, weakness, lack of endurance, or incoordination after repetitive use. The VA examiner reported IVDS signs of decreased sensation of the anterior, lateral, and posterior thighs, the inner knees, the front, medial and lateral legs, and the top of the feet and the lateral feet.

The panel directed attention to its rating recommendation based on the above evidence. The PEB provided a 0% rating based on OE as elaborated above. The VA rated the back condition 20%, coded 5242 (degenerative arthritis of the spine), based on the C&P examination, citing forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees.

The evidence of years of LBP history in the STR to the time of the Informal PEB supported a 10% rating. When the CI appealed to the Formal PEB, the physical therapy examination supported a 40% rating based on ROM. However, the total evidence in record did not support such a severe level of disability due to the condition. The post-separation VA examination supported a 20% rating based on ROM and/or the presence of muscle spasm with an abnormal gait. Members agreed that with consideration of functional loss, the CI’s disability due to the back condition at separation more nearly approximated the 20% rating criteria IAW VASRD §4.7 (higher of two evaluations). There was no evidence of IVDS with incapacitating episodes of at least 4 weeks duration for higher rating. The panel noted the PEB listed two back conditions of LBP and “right spondylolysis [sclerosis] of the left pars without evidence of spondylolisthesis.” However, the spondylolysis condition was a diagnosis related to the primary unfitting condition and not separately ratable (IAW VASRD §4.14, avoidance of pyramiding) and the panel recommends it as a Category II condition related to the LBP condition. After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 20% for the unfitting low back condition, coded 5299-5242.

Contended PEB Conditions: Transaminase Elevation and Obesity. The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting. The transaminase elevation condition, as an asymptomatic laboratory finding, had no impact on fitness and is not a VASRD-ratable condition. Obesity is a condition not constituting a physical disability, IAW DoDI 1332.38. Therefore, the panel has no basis for recommending either

condition as unfitting. After due deliberation, and in consideration of the preponderance of the evidence, the panel concluded t there was insufficient cause to recommend a change in the PEB fitness determination for these contended conditions and so no additional disability rating is recommended.

BOARD FINDINGS: In the matter of the low back pain, “right L5 spondylolysis [sclerosis] of the left pars, without evidence of spondylolisthesis,” low grade squamous intraepithelial lesion, hematuria, possible chronic glomerulonephritis, and patellofemoral syndrome, the panel recommends adjudication as follows: an unfitting low back pain condition, rated 20%, coded 5299-5242 IAW VASRD §4.71a, with a Category II condition of “right L5 spondylolysis of the left pars, without evidence of spondylolisthesis” and not unfitting low grade squamous intraepithelial lesion, hematuria, possible chronic glomerulonephritis and patellofemoral syndrome conditions. In the matter of the contended transaminase and obesity conditions, the panel recommends no change from the PEB determination as not unfitting. 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	
Low Back Pain	5299-5242	20%	

The following documentary evidence was considered:

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 12 Oct 20

From: To:

Subj:

Ref:

Director, Secretary of the Navy Council of Review Boards 
PHYSICAL DISABILITY BOARD OF REVIEW (PDBR)
(a) DoDI 6040.44
(b)	PDBR ltr of 29 Nov 19
(b)	

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

2.	On 7 October 2020, the Assistant Secretary of the Navy (Manpower & Reserve Affairs) took action in your case by accepting the recommendation of the PDBR. Accordingly, your records will be corrected to reflect an increase in the disability rating awarded by the Department of the Navy Physical Evaluation Board (PEB) from 0% to 20% without re-characterization of your discharge.

3.	For your information, since all disability ratings from 0% to 20% qualify for disability severance pay, the above stated increase will not result in your entitlement to additional compensation.

4.	The Assistant Secretary's determination, which represents final action in your case by the Department of the Navy, has been forwarded to the Navy Personnel Command for appropriate changes to your personnel records and notification to you upon completion.