RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01013
BRANCH OF SERVICE:  Marine Corps 	SEPARATION DATE:  20020430

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an Active Duty E3, Motor Vehicle Operator, medically separated for “mechanical low back pain” with a disability rating of 10%.  

CI CONTENTION:  The CI contends that his condition has worsened over time.  The complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The panel’s scope of review is defined in DoDI 6040.44.  It is limited to review of disability ratings assigned 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 or non-compensable.  Any conditions outside the panel’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 panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The panel’s assessment of the PEB rating determination is based on 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(s) at the time of separation.  The panel 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 panel 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 - 20020208	VARD - 20020530	
Condition	Code	Rating	Condition	Code	Rating	Exam	

Mechanical Low Back Pain
	
5295
	10%	Degenerative Disc Diseases of the Lumbar Spine	5010-5292	10%	20010313	
Degenerative Disc Disease	Cat II					
Bilateral Great Toe Hallux Valgus, Surgically Corrected 	Cat III
(not unfitting)	Residual Status Post Right Bunionectomy	5280	10%	20010313	
		Residual Status Post Left Bunionectomy 	5280	10%	20010313	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Mechanical Low Back Pain.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s low back pain condition began in August 1999 after carrying a stretcher loaded with a service member.  The other three stretcher carriers “gave way” resulting in a hyperextension injury to the CI’s lumbar spine.  Pain was immediate, but became variable thereafter.  Bone scan in June 2000 was negative for stress fracture or spondylolysis.  Plain film X-rays in September 2001 were unremarkable.  Magnetic Resonance Imaging (MRI) that was cited in the NARSUM but not available for review showed broad based disk bulge at L5-S1 with desiccation (degenerative disc disease).  There was no surgical indication and despite conservative treatment, the low back pain condition could not be adequately rehabilitated.  

At the 28 September 2000 VA Compensation and Pension (C&P) evaluation, performed 19 months before separation, the CI reported constant stiffness and weakness.  Physical examination showed normal gait, painful motion in all directions, mild paralumbar muscle spasm at L4-5 and no evidence of tenderness or weakness.  Range of motion (ROM) of the lumbar spine was reported as flexion to 60 degrees, extension 20 degrees, right and left lateral flexion 20 degrees each, right and left rotation 30 degrees each.  

At the 12 March 2001 VA C&P evaluation, performed 13 months before separation, physical examination showed painful motion, no muscle spasm or weakness, tenderness over the lumbar vertebral processes and lower paraspinous muscles.  Flexion was 70 degrees, extension 30 degrees, right and left lateral flexion was 40 degrees, and right and left rotation was 35 degrees.  Gait was abnormal with the CI walking on the outer lateral aspects of his feet but was not impacted by his back condition.  

The 23 November 2001 MEB NARSUM examination, 5 months prior to separation, noted complaints of localized lumbar area pain, with no radiating pain reported.  The CI reported difficulty with all physical activity to include working on vehicles, driving (civilian and military), and walking greater than 30 minutes.  Physical examination showed the CI able to flex forward with his fingers reaching within 10-12 inches of the ground with minimal dyskinetic motion present.  Pain with extremes of flexion greater than extension was present.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the mechanical low back pain condition 10%, coded 5295 (lumbosacral strain).  The Navy PEB also listed “degenerative disc disease” as a related category II condition (condition that contributes to the primary unfitting condition but is not separately ratable).  The panel agreed the impairment from this conditions is properly subsumed under the overall rating for the “mechanical low back pain condition” (§4.14 avoidance of pyramiding; more than one rating based on the same impairment is prohibited).  The VA rated the back condition 10% dual coded 5010-5292 (Arthritis, due to trauma - spine limitation of motion, slight), based on the C&P examination 11 months before separation, citing slight limited motion of the spine.  

The evidence did not support greater than slight limitation of lumbar motion, under code 5292 or muscle spasms on extreme forward bending, loss of lateral spine motion for any higher rating than that adjudicated by the PEB.  There was no documentation of intervertebral disc syndrome (IVDS) with incapacitating episodes which would provide for a higher rating under that formula (for IVDS).  

After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the back condition.  

BOARD FINDINGS:  In the matter of the mechanical low back pain back condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  There are no other conditions within the panel’s scope of review for consideration.  

The panel, therefore, recommends that there be no modification or re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150609, 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

      In accordance with reference (a), I have reviewed the cases listed below and 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 USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC

		
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