RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00676
BRANCH OF SERVICE:  Marine Corps	SEPARATION DATE:  20020228

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Marine Rifleman, Security Force Guard, and Basic Motor Transportation, medically separated for “degenerative lumbar disc disease L4-L5” with a disability rating of 10%.  

CI CONTENTION:  “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 - 20111211	VARD - 20020213	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Degenerative Lumbar Disc Disease L4-L5	5293	10%	DJD, Lumbar Spine…	5010-5292	20%	20020117	
Spondylolisthesis	Cat II					
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:

Degenerative Lumbar Disc Disease L4-L5 (Category II Spondylolisthesis).  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s low back condition began in approximately July 2000 after heavy physical training.  Both radiographic (X-rays) and diagnostic (MRI) imaging revealed grade 1 spondylolisthesis L5 on S1 with probable spondylolisthesis at L5.  Magnetic Resonance Imaging (MRI) performed on 3 December 2000 showed “a grade I spondylolisthesis of L5 on S1 with bilateral spondylolysis, a right paracentral disc protrusion at L4-L5 which abuts the right L5 nerve root within the lateral recess and posteriorly displaces it” and a bilateral L5 spondylolysis.  The CI received various conservative treatment modalities including physical therapy and an exercise program. Additionally, orthopedic consultation opined that the CI was not an operative candidate for these conditions.  The MEB forwarded “spondylolisthesis grade 1 L5-S1 and degenerative lumbar disc disease L4-L5” for PEB adjudication.  

At a primary care appointment on 5 September 2000, the CI complained of continuing lower back pain for 2 weeks duration.  The CI denied any radicular symptoms of numbness to the area.  The examiner observed the CI had a slightly antalgic gait.  Physical examination showed tenderness to palpation at the right lumbar paraspinal with back extension and discomfort with full range of motion (ROM).  Motor and sensory evaluations were normal and normal findings.  

The MEB NARSUM examination on 13 November 2001, 4 months prior to separation, noted complaints of increased persistent low back pain; aggravated by moderate physical activity.  The physical examination showed point tenderness of the lumbar spine with mild restriction of the flexion to approximately 70 degrees.  The neurological evaluation was normal.  

At the 17 January 2002 VA Compensation and Pension (C&P) evaluation, performed 1 month before separation, the CI reported constant lumbar spine pain exasperated by bending and relieved only be lying on the floor and resting.  The CI stated that he took Naproxen and Valium without any benefit.  ROM of the lumbosacral spine was noted as slightly limited at 75 degrees.  The gait and posture was noted as normal.  During physical examination, the CI demonstrated a positive Waddell sign in that compression of the shoulders and hand resulted in an exaggerated pain in the lumbosacral region.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the lumbar spine condition 10%, coded 5293 (intervertebral disc syndrome).  The VA rated the lumbar spine condition 20%, analogously coded 5010-5292 (arthritis due to trauma - spine, limitation of motion of, lumbar) based on the VA C&P examination 1 month before separation, citing moderate limitation of motion.  The Board noted that the NARSUM and VA examinations demonstrated decreased thoracolumbar ROM to 70-75 degrees.  There was not any evidence of spasms or significant tenderness to palpation nor gait abnormalities.  Board members agreed that the evidence supports a 10% rating for slight limitation of motion (5292).  The Board noted that the PEB rated the condition as intervertebral disc syndrome.  There was no evidence of moderate recurring attacks for a 20% 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 lumbar disc disease condition.  

Contended PEB Conditions:  Spondylolisthesis.  The Board’s main charge is to assess the fairness of the PEB’s determination that the contended condition contributed to the unfitting condition.  The clinical manifestation of spondylolisthesis is back pain; therefore IAW §4.14 (Avoidance of pyramiding) this condition could not be separately rated and contributed to the unfitting condition.  After due deliberation, the Board concluded that there was insufficient cause to recommend a change in the PEB determination for the contended condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the degenerative lumbar disc disease L4-L5 condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the spondylolisthesis condition, 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 20150530, 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 7 Dec 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
	     				 	Assistant General Counsel
						  	(Manpower & Reserve Affairs)