RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03135
BRANCH OF SERVICE:  Marine Corps 	SEPARATION DATE:  20060630

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a Marine Corps Reserve E3, Motor Vehicle Operator, medically separated for “herniated disc L4-L5, central without radiculopathy” with a disability rating of 20%.

CI CONTENTION:  The CI made no specific contention in the application.  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 - 20060417	VARD - 20070205	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Herniated Disc L4-L5	5237	20%	Degenerative Joint Disease Lumbar Spine	5242	0%	STR	
Chronic Low Back Pain	Category II					
Degenerative Disc Disease						
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Herniated Disc L4-5, Central without Radiculopathy.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s low back condition began in November 2004 after stacking sandbags while deployed.  An MRI showed a midline disc herniation at L4-5.  Despite treatment with medications including naproxen (a nonsteroidal anti-inflammatory drug), cyclobenzaprine (a muscle relaxer), cortisone injections (which provided some relief), physical therapy (PT), and chiropractic manipulations the back condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for an MEB.  The CI was given the option for surgery, but decided against it.  The MEB forwarded “displacement of lumbar intervertebral disc without myelopathy,” “degeneration of lumbar or lumbosacral intervertebral disc” and “lumbago” for PEB adjudication.

The MEB NARSUM examination on 4 April 2006, 3 months prior to separation, noted the CI’s complaints of pain in the midline of the back without radiation following an epidural steroid injection.  A physical examination showed the CI had reduced range of motion (ROM) of flexion to 70 degrees (normal 90) and combined ROM of 210 degrees (normal 240).  The examiner noted review of radiographic studies showed a relative loss of lumbar lordosis that was consistent with muscle spasms.  The CI did not present for the scheduled VA Compensation and Pension (C&P) evaluation.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the “herniated disc L4-5, central without radiculopathy” condition 20% coded 5237 (lumbosacral strain), likely due to muscle spasm severe enough to result in an abnormal spinal contour.  The Navy PEB also listed “chronic low back pain” and “degenerative disc disease” as related Category II conditions (conditions that contributed to the primary unfitting condition but were not separately ratable).  The impairment from the “chronic low back pain” and “degenerative disc disease” were properly subsumed under the overall rating for the “herniated disc L4-5, central without radiculopathy” IAW §4.14 (avoidance of pyramiding; more than one rating based on the same impairment is prohibited).  The VA rated the degenerative joint disease lumbar spine condition 0% coded 5242 (degenerative arthritis of the spine), due to the CI not attending the scheduled VA C&P evaluation.  The Board agreed that a 20% rating, but no higher, was justified for muscle spasm or guarding severe enough to result in an abnormal gait or spinal contour, reported on the NARSUM examination.  There was no documentation of ankylosis, flexion 30 degrees or less, or the intervertebral disc syndrome (IVDS) with incapacitating episodes 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, and 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 low back pain condition.  

BOARD FINDINGS:  In the matter of the herniated disc L4-5, central without radiculopathy 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.  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 20140520, with 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 6 Jul 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:

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

						  	XXXXXXXXXXXXXXXXXXXX
	     				  		Assistant General Counsel
						 	 (Manpower & Reserve Affairs)