RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2013-01941
BRANCH OF SERVICE:  MARINE CORPS 	SEPARATION DATE:  20060115

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-3, Mortarman, medically separated for a Scheuermann’s disease.  The condition could not be adequately rehabilitated to satisfy the physical requirements of his Military Occupational Specialty.  He was placed on limited duty (LIMDU) and referred for a Medical Evaluation Board (MEB).  The Back condition, characterized as “juvenile ostechondrosis of spine” and “pain in thoracic spine,” was forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated “Scheuermann’s Disease” as unfitting, rated 10%,  and “chronic thoracic spine (T-Spine) pain” as a Category II condition (contributes to the unfit condition) with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.  

CI CONTENTION:  He was not evaluated for his renal condition.  His complete submission is at Exhibit A.

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 when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting.  Any conditions outside the Board’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/Naval Records.  Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the VASRD standards to the unfitting medical condition at the time of separation.  The Board 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, operating under a different set of laws.  The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation. 

RATING COMPARISON 

IPEB - Dated 20050922	VA* - (~2 Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Scheuermann's  Disease	5299-5237	10%	Scheuermann’s Disease w/mild DDD and Thoracic Pain	5299-5243	40%	20060303	
Chronic T-Spine Pain	CAT II					
Other Conditions x 0 (Not In Scope)	Other x 0	
RATING:  10%	RATING:  40%	
*Derived from VA Rating Decision (VARD) dated 20060907 (Closes to date of separation [DOS]).  

ANALYSIS SUMMARY:  

Scheuermann’s Disease.  The earliest service treatment record (STR) contained in the case file was an ambulance report dated August 2004 whereby the CI complained of severe back pain.  The CI’s medical history (on the ambulance report) indicated Scheuermann’s disease (a developmental spine disorder resulting in “wedge-shaped” vertebrae causing pain and abnormal contour).  His back pain progressively worsened over the remainder of his service career.  The STR contained numerous emergency room encounters, physical therapy (PT) reports, and radiologic evaluations, all of which at some point indicated Scheuermanns disease as the cause of his persistent back pain as well as a variety of associated symptoms.  After neurology and orthopedic consultations, the CI was followed by pain management.  Despite all recommended treatment modalities, the CI’s pain symptoms improved, but not resolved.  He was placed on LIMDU on 29 April 2005 and eventually referred to a MEB.  At the MEB narrative summary examination (9 May 2005; 8 months prior to separation), the CI reported T-spine pain that was somewhat controlled with multiple medications.  There was no comment in regards to any associated radicular symptoms into his extremities.  The physical examination (PE) revealed T-spine tenderness and decreased thoracolumbar range-of-motion (ROM).  Distal motor and strength testing were normal.  The diagnosis was Scheuermann's disease and chronic T-spine pain.  Six weeks prior to service separation, physical therapy (PT) revealed global limitation of the thoracolumbar spine without comment IRT painful motion. 

 At the VA Compensation and Pension (C&P) examination (30 March 2006; 10 weeks after separation), the CI reported severe pain about the entire spine with tingling into both legs and feet.  During flare-ups, he endorsed the need to sit down and described a feeling whereby he could barely move.  His PE revealed decreased and painful thoracolumbar ROM without evidence of atrophy, spasm, guarding, or weakness.  The goniometric ROM evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.

Thoracolumbar ROM
(Degrees)	MEB ~8 Mo. Pre-Sep
(20050509) 	PT ~6 weeks Pre-Sep
(20051201) 	VA C&P ~10 weeks Post-Sep
(20060330) 	
Flexion (90 Normal)	50	40	25	
Extension (30)	25	30	15	
Combined (240)	-	155	115	
Comment	tenderness; 	-	painful motion	
§4.71a Rating	10%	20%	40%	

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB and VA utilized similar analogous codes of 5237 (lumbosacral strain) and 5243 (intervertebral disc syndrome) respectively; rated 10% by the PEB and 40% (citing limited motion) by the VA.  Board members first acknowledged the clear ROM disparity between the PT and VA examinations, with very significant implications regarding the Board's rating recommendation.  Members therefore, focused their deliberations over the probative value between the two examinations, and carefully reviewed the Service file for corroborating evidence in the 12-month period prior to separation.  Based upon the totality of the record, all Board members agreed that despite a worsening of function as evidenced in the VA examination, the CI’s overall condition and ongoing symptom presentations remained more consistent irt functional mobility and ROM with the PT evaluation in December 2005; and therefore supported 20% impairment.  After extensive deliberation and mindfulness of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 20% for the Scheuermann's disease (back) condition.   

Other PEB Conditions.  Chronic T-spine pain was adjudicated by the PEB as a related Category II condition (one that contributes to the unfitting condition).  The Board Action Officer opined and members agreed that the T-spine pain is primarily relational in Scheuermann's disease and is included in the discussion above and therefore does not warrant consideration as a separately unfitting condition.  All related symptoms and functional impairments are subsumed under the ratings for thoracolumbar spine IAW VASRD §4.71a.

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 Scheuermann's disease (back) condition, the Board unanimously recommends a disability rating of 20% coded 5299-5243 IAW VASRD §4.71a.  In the matter of the chronic T-spine pain condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB’s adjudication of a category II condition.  There were no other conditions within the Board’s scope of review for consideration. 

RECOMMENDATION:  The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation:  

CONDITION	VASRD CODE	RATING	
Scheuermann's  Disease (Back) Condition	5299-5243	20% 	
COMBINED	20% 	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20131029, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR COMMANDER, NAVY PERSONNEL COMMAND
	         DEPUTY COMMANDANT, MANPOWER & RESERVE AFFAIRS	
	                          
Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR)
       RECOMMENDATIONS          

Ref:  (a) DoDI 6040.44
      (b) PDBR ltr dtd 18 Nov 15 ICO XXXXXXXXXXXXXXXXXXXX  	 
      (c) PDBR ltr dtd 17 Nov 15 ICO XXXXXXXXXXXXXXXXXXXX
	(d) PDBR ltr dtd 17 Nov 15 ICO XXXXXXXXXXXXXXXXXXXX

1.  Pursuant to reference (a) I approve the recommendations of the Physical Disability Board of Review set forth in references (b) through (d).

2.  The official records of the following individuals are to be corrected to reflect the stated disposition:

     a. XXXXXXXXXXXXXXXXXXXX, former USMC: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge.

     b. XXXXXXXXXXXXXXXXXXXX, former USMC: Entitlement to disability separation pay with a 10 percent disability rating (increased from 0 percent) effective date of discharge.

     c. XXXXXXXXXXXXXXXXXXXX, former USN: Placement on the Temporary Disability Retired List (TDRL) for a period of six months with a 60 percent disability rating beginning date of discharge and a final disability rating of 20 percent with entitlement to disability separation pay upon removal from the TDRL.

3.  Please ensure all necessary actions are taken to implement these decisions, including the recoupment of disability severance pay, if warranted, and notification to the subject members once those actions are complete.