RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2013-00204
BRANCH OF SERVICE:  MARINE CORPS	BOARD DATE:  20140401
SEPARATION DATE:  20041130

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty LCpl/E-3 (1371/Combat Engineer) medically separated for sacro-iliac (SI) joint pain.  The SI joint pain could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards.  He was placed on limited duty and referred for a Medical Evaluation Board (MEB).  Low back pain (LBP) and SI joint pain were forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E.  No other conditions were submitted by the MEB.  The PEB found the SI joint pain unfitting, rated 10%, with likely application of the VA Schedule for Rating Disabilities (VASRD).  LBP was adjudicated as Category II.  The CI requested reconsideration, but waived a formal hearing and was medically separated.

CI CONTENTION:  “The 10 percent compensation received was a slap in the face for the years of service and commitment to my Country.  I suffered a severe back injury which resulted in me not being able to continue my service to my country as well as my dream of being a lifer in the service.  The $96 dollars received monthly did nothing to assist me in my battle to transition into the civilian world. I was barely able to stand and the only job I was able to get at the time of my departure was a standing security guard position.  I had to tell them I was fine just so they would consider hiring me.  Only through friends, not the VA was I able to find an office job.  I spent four years standing in agony as a security guard to support a household and marriage.  Please review my medical records fairly.  Please know that I am a person and not a case number, and that I was so badly hurt and emotionally devastated that I was only given 96 dollars a month.  It is not fair, I made the sacrifice to serve and take care of my country during a time of war, in return I ask that you help and do the right thing.  This injury affects me daily; I depend on so many others for help, that's degrading for a man.  I can't lift things, I can't run.  When I walk for exercise, I have to take medicine so I won't be in such pain that I become an irate person that no one wants to be around.  I'm sure I can continue on, but please be fair.  Please review my medical records and any consideration for more compensation would be greatly appreciated.  The older I get the harder it is to deal with the injury.

SCOPE OF REVIEW: The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e.(2).  It is limited to those conditions determined by the PEB to be unfitting for continued military service and those conditions identified but not determined to be unfitting by the PEB when specifically requested by the CI.  The rating for the unfitting SI joint pain is addressed below.  The LBP is also addressed below.  No other conditions are within the defined purview of the Board.  Any conditions outside the Board’s scope of review may be eligible for consideration by the Board for Correction of Naval Records.

RATING COMPARISON:

Service IPEB – Dated 20040812	VA - (2 Mos. Post-Separation) 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Sacro-Iliac Joint Pain 	5236	10%	Lumbosacral Strain w/bilateral neuropathy, lower extremities	5237	10%	20050131	
Low Back Pain	Category II					
No Additional MEB/PEB Entries	Other x 4	20050131	
Rating:  10%	Combined:  10%	
Derived from VA Rating Decision (VARD) dated 20050614 (most proximate to date of separation [DOS])

ANALYSIS SUMMARY: The Board acknowledges the CI’s information regarding the significant impairment with which his condition continues to burden him; but, must emphasize that the Disability Evaluation System has neither the role nor the authority to compensate members for anticipated future severity or potential complications of conditions resulting in medical separation.  That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws.

Sacro-iliac (SI) Joint Pain.  This Marine has had a long history of pain in the lumbosacral region.  Magnetic resonance imaging in March 2002 showed minimal left paracentral disc bulging at L5-S1, without evidence of any compressive disc disease.  He was treated with drugs, electrical stimulation, physical therapy and other non-operative measures.  However, his pain persisted and an MEB was initiated.  The MEB narrative summary was dated 14 May 2004.  On physical exam of the lumbar area he had slight flattening of lumbar lordosis, but no other deformity.  There was mild tenderness to palpation (TTP) of spinous processes L3 through S1.  Range-of-motion (ROM) of the lower back was measured, and is summarized in the chart below.  Examination of the sacral region revealed marked TTP of the SI joints bilaterally.  Gait was normal.  As noted above, the CI was medically separated on 30 November 2004.  Two months later, he had a VA Compensation and Pension (C&P) exam.  At that time, the CI reported constant pain in the lower back and both hips.  On exam, posture and gait were normal.  The ROM evaluations which the Board weighed in arriving at its recommendation are summarized in the chart below.

Thoracolumbar ROM
(Degrees)	MEB ~ 5½ mos. Pre-Sep
(20040514)	VA C&P ~ 2 mos. Post-Sep
(20050131)	
Flexion (90 Normal)	85	85	
Combined (240)	210	210	
Comment	gait normal	gait normal	
§4.71a Rating	10%	10%	

The Board carefully reviewed all available evidence and directs attention to its rating recommendation.  The Navy PEB and the VA chose different coding options for the CI’s chronic pain condition, but both rated it 10%.  The Board noted the similarity between the two examinations documented above.  At the May 2004 MEB exam, forward flexion was 85 degrees and combined thoracolumbar ROM was 210 degrees.  At the January 2005 C&P exam, forward flexion was also 85 degrees and combined thoracolumbar ROM was 210 degrees.  IAW the VASRD §4.71a, a 10% rating is warranted when thoracolumbar flexion is greater than 60 degrees, but not greater than 85 degrees.  A 10% rating is also warranted when combined thoracolumbar ROM is greater than 120 degrees, but not greater than 235 degrees.  After a thorough review of the evidence, the Board determined that a disability rating of 10% was appropriate.  The Board tried to find a path to a higher rating, using other codes which could be applied to the chronic pain condition.  The other VASRD codes that were considered did not result in a higher rating, since the treatment record did not show sufficient evidence of a disabling condition which would justify a rating higher than 10%.  The Board also considered the matter of peripheral neuropathy.  After reviewing all the information in the record, there was insufficient evidence of a clinically significant neuropathy that interfered with performance of military duties.  The CI clearly had radicular symptoms.  However, there was no performance-based evidence that the radicular condition impacted his military duties.  Therefore, the Board concluded that there was no unfitting radiculopathy present at separation.

Low back pain.  LBP was adjudicated by the PEB as Category II (related to the unfitting SI joint condition).  The Board determined that this condition was indeed related to the unfitting SI joint condition and did not constitute a separately unfitting condition for disability rating purposes.  Therefore, it is appropriate for LBP to be considered as Category II.

After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board found insufficient cause to recommend a change in the PEB adjudication for the CI’s chronic SI joint pain condition and the related LBP condition.  IAW VASRD §4.71a, the CI’s chronic pain condition meets criteria for a 10% rating due to forward flexion greater than 60 degrees, but not greater than 85 degrees; and combined thoracolumbar ROM greater than 120 degrees, but not greater than 235 degrees.

BOARD FINDINGS:  IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB will not be considered by the Board to the extent they were inconsistent with the VASRD in effect at the time of the adjudication.  The Board did not surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD were exercised.  In the matter of the SI joint pain condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the LBP condition, the Board unanimously recommends no change in the PEB finding as Category II.  There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION:  The Board, therefore, recommends that there be no recharacterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20130427, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

		

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW
               BOARDS 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS
 
Ref:   (a) DoDI 6040.44
       (b) CORB ltr dtd 28 Oct 14

      In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for the reasons provided in their forwarding memorandum, approve the recommendations of the PDBR the following individual’s records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy’s Physical Evaluation Board:

- XXXXXXXXXXXXXXXXXX, former USMC    
- XXXXXXXXXXXXXXXXXX, former USN  
- XXXXXXXXXXXXXXXXXX, former USN