RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02415
BRANCH OF SERVICE:  Marine Corps 	SEPARATION DATE:  20020515

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E2, Utilities Engineer Operator, medically separated for “degenerative disc disease L4/L5 and bilateral facet arthropathy L4/L5 and L5/S1,” with a disability rating of 10%.  

CI CONTENTION:  “Please review all conditions.”  The CI’s complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited 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 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 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 based upon a review of medical records and all available evidence for application of the 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:  

SERVICE PEB - 20020328	VARD - 20020603	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Degenerative Disk Disease L4/L5 and Bilateral Facet Arthropathy L4/L5	5295	10%	Lumbar Spine Degenerative Disc Disease L4-L5 with Bilateral Facet Arthropathy L5-S1	5299-5293	10%	2002417	
Hypothyroidism	Cat III	Hypothyroidism	7903	NSC		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Degenerative Disk Disease L4/L5 and Bilateral Facet Arthropathy L4/L5.  According to service treatment record and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s low back pain condition began in October 2000 as a recruit in training with no specific injury or trauma.  There was no surgical indication and after a series of conservative treatments including 6 months of limited duty the condition could not be rehabilitated to the point of allowing for unrestricted duty.  The MEB forwarded “degenerative disk disease L4/L5 and bilateral facet arthropathy L4L5” for PEB adjudication.  
The MEB NARSUM examination on 28 January 2002, 4 months prior to separation, noted complaints of consistently present back pain of varying intensity exacerbated by running, forced marches, and standing for greater than 45 minutes.  Physical examination showed full range of motion (ROM) of the back and no deformities noted.  The examiner cited several radiological (X-ray) studies; a 25 May 2001 L-spine series, left hip and pelvis that were significant for bilateral L4/L5 and L5/S1 facet arthropathy, a normal 21 June 2001 bone scan, and 03 October 2001 lumbar magnetic resonance imaging (MRI) which showed degenerative disc changes at L4/L5, mild left foraminal narrowing due to moderate bilateral facet arthropathy at L5/S1 and mild bilateral facet arthropathy at L4/L5.  

At the 17 April 2002 VA Compensation and Pension evaluation, performed 1 month prior to separation, the CI reported persistent low back pain that was not clearly related to any specific activity.  She did say that sitting for a long time or standing or walking for a long time exacerbated her back pain.  She used medication, massage, hot showers, rest and avoidance of activities to remain relatively asymptomatic.  Physical examination showed normal gait, full ROM of the lumbar spine but pain on motion, and positive straight leg raise test, though does not specify which leg.  The examiner noted no muscle spasms were present in the low back and noted bilateral facet arthropathy at L5/S1.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back pain condition 10%, coded 5295 (lumbosacral strain).  The VA also rated the low back pain condition 10%, analogously coded 5293 (intervertebral disc syndrome), citing painful motion and a positive straight leg raising test.  The CI did not have any evaluations proximate to separation with “moderate” limitation of lumbar motion; therefore, a 20% rating is therefore not supported.  There was no muscle spasm or guarding severe enough to result in an abnormal gait or spinal contour, thus the next higher 20% rating was not justified on this basis.  There was no documentation of intervertebral disc syndrome (IVDS) with moderate recurring attacks which would provide for a higher rating under that formula (for IVDS), or evidence of ratable peripheral nerve impairment which would provide for additional rating.  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 for the degenerative disk disease L4/L5 and bilateral facet arthropathy L4/L5 condition.  

Contended PEB Conditions:  Hypothyroidism.  The Board’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The contended condition was not profiled or implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the degenerative disk disease L4/L5 and bilateral facet arthropathy L4/L5 condition and IAW VASRD §4.72, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended hypothyroid condition, the Board unanimously recommends no change from the PEB determination as not unfitting.    There were no other conditions within the Board’s scope of review for consideration.  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 20140427, w/attachments
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 16 Nov 16

      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:

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