RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00688
BRANCH OF SERVICE:  Marine Corps	SEPARATION DATE:  20061031

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Light Armored Vehicle Crewman, medically separated for “multilevel degenerative disc disease,” with a disability rating of 0%.

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 - 20060915	VARD - 20070508	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Multilevel Degenerative Disc Disease	5237	0%	Lumbar Spondylosis L5-S1…DDD	5243	10%	20070405	
Back Pain	Cat II	Lumbar Radiculopathy of the Left Lower Extremity	8622	0%	20070405	
Spondylolysis L5						
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:

Multilevel Degenerative Disc Disease.  According to service treatment record and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s back pain condition began in December 2005 with no apparent mechanism of injury.  The CI had numerous radiographic (X-rays) workups to include magnetic resonance imaging (MRI) and computerized axial tomography (CT) myelograms, all of which showed multilevel degenerative disc disease with no neural compromise.  The CI was evaluated by two separate spine surgeons and neither surgeon recommended surgical treatment.  Despite treatment, 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 MEB.  The MEB forwarded “displacement of intervertebral disc, site unspecified, without myelopathy,” “congenital spondylolysis, lumbosacral region,” and “backache, unspecified” for PEB adjudication.

At the time of the orthopedic clinic appointment on 7 April 2006, noted complaints of left leg parenthesis and no lower back pain.  Physical examination showed a normal gait, normal heal to toe walk, normal sensation, and normal strength.  Range of motion (ROM) measurements showed flexion to 2 inches above the floor (normal 90), and a combined ROM of 220 degrees (normal 240); painful motion not addressed.  The MEB NARSUM examination on 2 August 2006 (3 months prior to separation) noted complaints of back and left lower extremity pain.  Physical examination showed lower lumbar L4-5 area tenderness and normal bilateral lower extremity strength.  ROM was flexion 90 degrees; painful motion not addressed.

At the 5 April 2007 VA Compensation and Pension (C&P) evaluation, performed 5 months after separation, noted complaints of intermittent low back without incapacitating episodes.  Physical examination showed a normal gait and posture, normal lumbar lordotic curvature, normal reflexes, and no differential muscle weakness in the lower extremities.  There was mild paravertebral muscle spasm and he was able to walk on his heels and toes.  ROM measures showed flexion to 90 degrees and combined ROM of 230 degrees with painful motion.  Repetitive motion caused weakness and fatigue.  Electromyography studies with nerve conduction velocities (EMG/NCV)] performed on 10 April 2007 were negative for radiculopathy.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the multilevel degenerative disc disease condition 0%, coded 5237 (lumbosacral strain).  The PEB listed the back pain and spondylolysis L5 conditions as related diagnoses (Category II) that contributed to the disability in this case.  The Board agreed that the back pain and spondylolysis L5 were diagnoses related to  the multilevel degenerative disc disease and were not  separate conditions which could be separately rated IAW §4.14 (avoidance of pyramiding; more than one rating based on the same impairment is prohibited).  The VA rated the back pain condition 10%, coded 5243 (intervertebral disc syndrome) based on the VA C&P examination 5 months after separation, citing limited combined ROM.  The VA also rated left lower extremity-lumbar radiculopathy 0%, coded 8622 (neuritis), citing mild-incomplete paralysis of foot movements.

The Board agreed that a 10% rating, but no higher, was justified for limitation of combined ROM reported on the orthopedic, MEB NARSUM, and VA, examinations.  Although there was muscle spasm, it was not 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 incapacitating episodes which would provide for a higher rating under that formula (for IVDS).

The Board also considered if additional disability rating was justified for peripheral nerve impairment due to radiculopathy.  Radiographic and electrodiagnostic studies supported radicular nerve irritation or involvement, but physical examinations orthopedic, MEB NARSUM, and VA C&P) proximate to separation revealed no objective findings of radiculopathy that would impact duty performance.  The presence of functional impairment with a direct impact on fitness is the key determinant in the Board’s decision to recommend any condition for rating as additionally unfitting.  While the CI may have suffered additional pain from the nerve involvement, this is subsumed under the general spine rating criteria, which specifically states “with or without symptoms such as pain (whether or not it radiates).”  Therefore the critical decision is whether or not there was a significant motor weakness which would impact military occupation-specific activities.  There was no evidence in this case that motor weakness existed to any degree that could be described as functionally impairing.  The Board therefore concluded that an additional disability rating was not justified on this basis.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the multilevel degenerative disc disease condition, coded 5237.

BOARD FINDINGS:  In the matter of the multilevel degenerative disc disease condition, the Board unanimously recommends a disability rating of 10%, coded 5237 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.  

The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	
Multilevel Degenerative Disc Disease	5237	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150602, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR COMMANDER, NAVY PERSONNEL COMMAND
	         DEPUTY COMMANDANT, MANPOWER & RESERVE AFFAIRS	
	                          
Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS          

Ref:  (a) DoDI 6040.44
	(b) PDBR ltr dtd 03 Nov 16 ICO XXXXXXXXXXXXXXXXXX    
	(c) PDBR ltr dtd 21 Oct 16 ICO XXXXXXXXXXXXXXXXXX
	(d) PDBR ltr dtd 24 Oct 16 ICO XXXXXXXXXXXXXXXXXX
	(e) PDBR ltr dtd 28 Oct 16 ICO XXXXXXXXXXXXXXXXXX
	(f) PDBR ltr dtd 21 Oct 16 ICO XXXXXXXXXXXXXXXXXX
	(g) PDBR ltr dtd 03 Nov 16 ICO XXXXXXXXXXXXXXXXXX
	(h) PDBR ltr dtd 28 Oct 16 ICO XXXXXXXXXXXXXXXXXX
	(i) PDBR ltr dtd 28 Oct 16 ICO XXXXXXXXXXXXXXXXXX
	(j) PDBR ltr dtd 28 Oct 16 ICO XXXXXXXXXXXXXXXXXX
	(k) PDBR ltr dtd 28 Oct 16 ICO XXXXXXXXXXXXXXXXXX
	(l) PDBR ltr dtd 03 Nov 16 ICO XXXXXXXXXXXXXXXXXX

1.  Pursuant to reference (a), the recommendations of the Physical Disability Board of Review set forth in references (b) through (l) are approved.

2.  The official records of the following individuals are to be corrected to reflect the stated disposition:

     a. XXXXXXXXXXXXXXXXXX, former USN: Entitlement to disability separation pay with a 20 percent disability rating (increased from 0 percent) effective date of discharge. 

     b. XXXXXXXXXXXXXXXXXX, former USMC: Entitlement to disability separation pay with a 20 percent disability rating (increased from 0 percent) effective date of discharge. 

     c. XXXXXXXXXXXXXXXXXX, former USMC: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge. 

     d. XXXXXXXXXXXXXXXXXX, former USN: Entitlement to disability separation pay with a 10 percent disability rating (increased from 0 percent) effective date of discharge. 

     e. XXXXXXXXXXXXXXXXXX, former USN: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge. 

     f. XXXXXXXXXXXXXXXXXX, former USN: Entitlement to disability separation pay with a 10 percent disability rating (increased from 0 percent) effective date of discharge. 

     g. XXXXXXXXXXXXXXXXXX, former USMC: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge. 

     h. XXXXXXXXXXXXXXXXXX, former USN: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge. 

     i. XXXXXXXXXXXXXXXXXX, former USMC: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge. 

     j. XXXXXXXXXXXXXXXXXX, former USMC: Entitlement to disability separation pay with a 10 percent disability rating (increased from 0 percent) effective date of discharge.

     k. XXXXXXXXXXXXXXXXXX, former USN: Entitlement to disability separation pay with a 10 percent disability rating (increased from 0 percent) effective date of discharge.   

3.  Please ensure all necessary actions are taken to implement these decisions, including the recoupment of disability severance pay, if warranted, and notification to the subject members once those actions are complete.

	XXXXXXXXXXXXXXXXXX
	Assistant General Counsel
						   (Manpower & Reserve Affairs)