RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXXX	CASE: PD-2018-00049
BRANCH OF SERVICE: NAVY	SEPARATION DATE: 20070810

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Field Medical Service Technician, medically separated for “left paracentral disk protrusion at L5-S1 contacting and displacing posteriorly the left S1 nerve root” with a disability rating of 10%.

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 - 20070625	VARD - 20071101	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Left Paracentral Disk Protrusion at L5-S1 Contacting and Displacing Posteriorly the
Left S1 Nerve Root	
5243	
10%	

Lumbar Degenerative Disc Disease	

5242	

20%	

20070720	
Suggestion of Protrusion of the Disk at T11-12 on the Sagittal
Images	Cat II					
Lumbar Inter Vertebral Disk
Degeneration Multilevel	Cat II					
Spondylosis as Described
Above	Cat II					

Post-Traumatic Stress Disorder (PTSD)	
Cat III	Major Depressive Disorder and
Anxiety Disorder, Not Otherwise Specified	9400-9434	30%		
		PTSD	9411	NSC		
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 50%	

ANALYSIS SUMMARY:

Left Paracentral Disk Protrusion at L5-S1 Contacting and Displacing Posteriorly the Left S1 Nerve Root. According to the service treatment record and MEB narrative summary (NARSUM), the CI’s low back condition began in May 2006 after twisting the wrong way. Radiographic imaging from October 2006 showed multilevel spondylosis. There was no surgical indication. The 9 April 2007

MEB NARSUM examination, 4 months prior to separation, noted complaints of lumbar pain. Physical examination showed lumbar spine range of motion (ROM) measured as flexion greater than 50 degrees (normal 90), extension greater than 45 (normal 30), rotation greater than 30 (normal 30), and lateral bending greater than 30 (normal 30).

At the 20 July 2007 VA Compensation and Pension (C&P) examination, one month before separation, the CI reported constant pain with stiffness and weakness. Physical examination revealed evidence of paraspinal muscle spasm. There was no evidence of tenderness or weakness. There was no evidence of radiation of the pain. Goniometer-measured ROM recorded flexion of 55 degrees and combined ROM of 175 degrees (normal 240) with painful motion in all directions. There was no evidence of intervertebral disc syndrome (IVDS). ROM of the thoracolumbar spine was limited by pain and lack of endurance after repetitive use with pain having the major functional impact. It was not limited by fatigue, weakness or incoordination after repetitive use; and there was no additional limitation of motion.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the low back condition 10%, coded 5243 (IVDS). The PEB also listed suggestion of protrusion of the disk at T11-12 on the sagittal images, lumbar inter vertebral disk degeneration and multilevel spondylosis as described above as related Category II conditions that contributed to the primary unfitting condition but were not separately ratable. The impairment from the Category II conditions was properly subsumed under the overall rating for the left paracentral disk protrusion at L5-S1 contacting and displacing posteriorly the left S1 nerve root condition IAW
§4.14 (avoidance of pyramiding; more than one rating based on the same impairment is prohibited). The VA rated the low back condition 20%, coded 5242 (degenerative arthritis of the spine), based on the C&P examination, citing paraspinal muscle spasm; limited and painful motion with 55 degrees of forward flexion and 175 degrees of combined thoracolumbar motion.

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 NARSUM and VA examinations. There was no documentation of IVDS 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 recommends a disability rating of 20% for the low back condition, coded 5243.

Contended PEB Condition: PTSD. The panel’s main charge is to assess the fairness of the PEB determination that the contended condition was not unfitting. The contended condition was not noted on limited duty forms, implicated in the non-medical assessment, and did not fail retention standards. The NARSUM noted impairment and symptoms were mild. There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation. After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition, so no additional disability rating is recommended.

BOARD FINDINGS: In the matter of the left paracentral disk protrusion at L5-S1 contacting and displacing posteriorly the left S1 nerve root condition, the panel recommends a disability rating of 20%, coded 5243 IAW VASRD §4.71a. In the matter of the contended PTSD condition, 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	
Left Paracentral Disk Protrusion at L5-S1 Contacting
and Displacing Posteriorly the Left S1 Nerve Root	5243	20%	

DEPARTMENT OF THE NAVY
SECRETARY OF TIIB 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 26 Mar 20
(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 10% 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.
1.