RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	    CASE:  PD-2014-00637
BRANCH OF SERVICE:  MARINE CORPS 	SEPARATION DATE:  20060515

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5 (Main Battle Tank Repair Technician) medically separated for a lumbar spine condition which could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS).  He was placed on limited duty (LIMDU) and referred for a Medical Evaluation Board (MEB).  The “spinal stenosis of lumbar region,” was forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E.  The MEB also identified and forwarded two other conditions (unspecified neuralgia, neuritis, and radiculitis and spina bifida without mention of hydrocephalus, lumbar region) for PEB adjudication. The Informal PEB (IPEB) adjudicated “spinal stenosis at levels L4-5” as unfitting, rated 20%.  The remaining conditions were determined to be Category II (contributing to unfit).  The CI made no appeals and was medically separated.  

CI CONTENTION:  The applicant makes no specific contention in his application.  His complete submission is in 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 Veterans Affairs Schedule for Rating Disabilities (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 20060306	VA* - (1 Mo. Pre-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Spinal Stenosis at Levels L4-5	5237	20%	Lumbar Strain with Intervertebral Disc Syndrome, and Compression Left Sciatic L5-S1	5243-5237	10%	20060411	
Spina Bifida Occulta at Levels S1-2	Category II					
Lumbar Radiculopathy						
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 14 (equals SC, NSC & deferred)	
RATING:  20%	RATING:  70%	
*Derived from VA Rating Decision (VARD) dated 20060525(most proximate to date of separation [DOS]).  

ANALYSIS SUMMARY:    

Lumbar Spine Condition.  The service treatment record (STR) corroborates the history in the narrative summary (NARSUM) of an initial injury in March 2003 when a tent pole fell on the CI’s back (Kuwait, 3 years pre-separation).  He experienced persistent pain with intermittent left lower extremity (LLE) radiation and sensory symptoms.  Degenerative disc disease (bulge at L4/5 with “moderate central and lateral recess stenosis”) was diagnosed by magnetic resonance imaging, and a trial of conservative management was unsuccessful at restoring MOS functionality.  There are multiple STR entries confirming normal neurological findings (5/5 LLE strength, normal reflexes, no significant sensory deficits), with none to the contrary; and, the CI reasonably declined consideration of a surgical option.  There is ample STR documentation of normal gait and spinal contour, grossly normal or minimally limited range-of-motion (ROM), and no periods of incapacitation.  

The NARSUM was conducted 16 December 2005 (5 months pre-separation) and documented back pain with LLE radiation (to knee).  The NARSUM examiner documented intermittent (“every two weeks lasting several hours at a time”) LLE numbness and subjective weakness (the latter not noted in STR outpatient entries); and, noted limitations with running, prolonged standing or walking, and lifting over 20 pounds.  The NARSUM physical examination recorded a normal gait, “slight” tenderness, and normal neurological findings (5/5 LLE strength and no sensory deficits).  Measured ROM by the NARSUM examiner was flexion to 50 degrees (normal 90), extension to 10 degrees (normal 30), and bilateral side bending to 20 degrees (normal 30).  Formal ROM measurements for the MEB by physical therapy (same day as NARSUM) were flexion to 60 degrees and combined ROM of 200 degrees (normal 240).

A VA Compensation and Pension (C&P) examination was conducted 11 April 2006 (one month pre- separation) and documented “constant” pain rated 8/10 with LLE radiation “elicited by physical activity.”  The VA physical examination recorded a normal gait and spinal contour, tenderness, spasm, and normal neurological findings (strength, sensory, and reflexes).  The VA measured ROM was flexion to 90 degrees and combined 220 degrees.

The Board directed attention to its rating recommendation based on the above evidence.  It is first clarified that the Category II spinal bifida occulta condition was an incidentally noted anatomic variant on X-ray; and, does not constitute a separately ratable condition.  The associated Category II lumbar radiculopathy is addressed below.  The PEB’s 20% rating utilizing code 5237 (lumbar strain) was consistent with VASRD §4.71a criteria for the Service findings and ROM evidence.  The VA’s 10% rating was consistent with the C&P findings and ROM evidence.  There is no Service or VA evidence supporting a rating higher than 20%, and no indication of incapacitating episodes to support a higher rating under that formula.  Members also considered additional rating for the LLE radiculopathy, but the pain component is subsumed under the general spine rating IAW §4.71a and there is clear evidence that there was no ratable sensory or motor impairment.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication of the lumbar spine condition.

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 lumbar spine condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration. 
RECOMMENDATION:  The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140124, 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 21 Dec 15

      In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for the reasons provided in their forwarding memorandums, approve the recommendations of the PDBR that 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:

- XXXXXXXXXXXXXXXXXXXXX former USMC
- XXXXXXXXXXXXXXXXXXXXX former USMC
- XXXXXXXXXXXXXXXXXXXXX former USMC  
- XXXXXXXXXXXXXXXXXXXXX former USMC
- XXXXXXXXXXXXXXXXXXXXX former USMC
- XXXXXXXXXXXXXXXXXXXXX former USMC 

						  XXXXXXXXXXXXXXXXXXXXX
	     				  Assistant General Counsel
						  (Manpower & Reserve Affairs)