RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02021
BRANCH OF SERVICE:  MARINE CORPS 	BOARD DATE:  20150313
SEPARATION DATE:  20061031

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5 (Field Artillery Fire Control Man) medically separated for back pain.  The condition 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).  The condition characterized as “post laminectomy syndrome, lumbar region” was forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E.  The MEB also identified and forwarded three other conditions; “lumbago”, “unspecified neuralgia, neuritis, and radiculitis” and “displacement of intervertebral disc, site unspecified, without myelopathy” for PEB adjudication.  The Informal PEB adjudicated “post laminectomy syndrome” as unfitting, rated 20%, with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The remaining conditions were determined to be Category II, conditions contributing to unfit.  The CI made no appeals and was medically separated.  

CI CONTENTION:  The CI requested that the Board review all of his conditions.  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 20060612	VA* - (~3 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Post Laminectomy Syndrome	5237	20%	Status Post Laminectomy, Degenerative Disc
Disease(DDD)-Lumbar Spine	5242	10%	20070116	
Herniated Right L5-S I Disc	Cat II					
Lumbago	Cat II					
History of Right Si Radiculopathy	Cat II	No VA Placement	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 7 	
RATING:  20%	RATING:  40%	
*Derived from VA Rating Decision (VARD) dated 20070427 (most proximate to date of separation (DOS)).  

ANALYSIS SUMMARY:  

Post Laminectomy Syndrome.  The service treatment record reflected that the CI developed low back pain (LBP) with radicular symptoms into his right leg which began in late 2002 following physical training.  Failing conservative treatment with medications and rest, he underwent epidural steroid injections in late 2004 which provided only transient relief.  Radiologic tests performed on 19 January 2005 revealed a right-sided lumbosacral disc protrusion associated with S-1 nerve root compression.  His radicular component was pain only without numbness or weakness.  On 20 April 2005 the CI underwent a neuro-surgically directed laminectomy and nerve decompression.  On the third day after surgery the CI re-injured his low back while getting out of a car.  Eventually he had a second surgery on 12 July 2005.  A neurosurgical clinical encounter dated 13 September 2005, 6 weeks post his second surgery; the examiner noted that the CI is “doing well” and “ready to resume full duty.”  In April 2006, 7 months prior to separation, the CI’s leg pain was “resolved” and he endorsed only “occasional” back pain.  He reported “…returned to golfing without marked increase in pain.”  Secondary to back pain in the presence of lumbar arthritis, he was sent for an MEB.  At the MEB narrative summary, 7 months prior to separation, the CI’s history was chronicled with ever present LBP.  The physical examination (PE) was normal without descriptive range-of-motion (ROM), comment on painful motion, or noting the presence of spasms.  Despite no comment in the PE, the examiner assessed “…he has persistent back pain resulting in multiple episodes of spasm.”    

At the VA Compensation and Pension (C&P) examination, 3 months after separation, the CI endorsed constant back spasms with bi-weekly back pain flare-ups precipitated by movement and lasting for hours.  The PE revealed decreased and painful motion and also described both a “normal” and an “antalgic” gait.  Radiology noted degenerative disc disease of the lumbosacral spine.  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.
DOS 20061031
Thoracolumbar ROM
(Degrees)	
Neurosurg/MEB ~7 Mo. Pre-Sep
(20060404) 	VA C&P ~3 Mo. Post-Sep
(20070116) 	
Flexion (90 Normal)	

“FROM”	65	
Extension (30)		30	
R Lat Flexion (30)		30	
L Lat Flexion (30)		30	
R Rotation (30)		30	
L Rotation (30)		30	
Combined (240)	240	215	
Comment	spasm	painful motion	
§4.71a Rating	10%	10%	

The Board directed attention to its rating recommendation based on the above evidence.  Although the PEB and VA titled the unfitting back condition slightly differently, they both utilized similar primary codes of 5237 (lumbosacral strain) and 5242 (degenerative arthritis) respectively; with the PEB citing no specific reason and the VA citing limited ROM.  Board members first acknowledged the flexion ROM values reported by the VA examiner, 3 months after separation were significantly worse than those reported in the pre-separation examination.  However, the degree loss does not support VASRD criteria greater than 10%.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), as well as the caveat that the Board’s recommendation may not produce a lower rating than that of the PEB, members concluded that there was insufficient cause to recommend a change in the PEB adjudication for the low back (laminectomy) condition.

Other PEB Conditions.  The PEB’s listing of diagnoses included a herniated right L5-S1 disc, lumbago (back pain), and history of right sacroiliac radiculopathy as Category II (a condition that contributes to the unfit condition).  The Board unanimously agreed that all three conditions were either etiologic factors that precipitated the requirement for surgical intervention or a resolved condition as a result of surgery.  All conditions were intimately involved with the entirety of the low back and all related symptoms and functional impairments were subsumed under the rating for the post-laminectomy condition as noted above. 

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 low back (post-laminectomy) condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended herniated right L5-S1 disc, lumbago, and history of right sacroiliac radiculopathy conditions, the Board unanimously recommends no change from the PEB determination as Category II conditions which contributed to the primary unfitting condition.  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 20140505, 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 30 Nov 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:

- XXXXXXXXXXXXXXXXXXXX, former USMC  
- XXXXXXXXXXXXXXXXXXXX, former USMC 
- XXXXXXXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXXXXXXX, former USMC

						  XXXXXXXXXXXXXXXXXXXX
	     				  Assistant General Counsel
						  (Manpower & Reserve Affairs)