RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01644
BRANCH OF SERVICE:  Marine Corps 	SEPARATION DATE:  20020815

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E2, Basic Marine, medically separated for “posttraumatic arthrosis, left sacroiliac joint,” with a disability rating of 10%.  

CI CONTENTION:  The CI contends his condition continues to affect his ability to work.  He requests all conditions be reviewed.   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 - 20020618	VARD - 20021008	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Posttraumatic Arthrosis, Left Sacroiliac Joint	5299-5295	10%	Sacroiliac Joint Diastasis, Post Traumatic Arthrosis	5294	10%	20020702	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Posttraumatic Arthrosis, Left Sacroiliac Joint (SI).  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s low back/pelvis condition began in February 2002 after a fall during recruit training.  The CI had immediate sacroiliac/lower back pain.  Radiographic (X-ray) studies showed a “widened left SI joint.”  Magnetic resonance imaging (MRI) showed “increase signal in the region of the left SI joint.”  Nuclear bone scan showed “4+ intense uptake in the left SI joint, and a computerized tomography (CT) scan showed “increased sclerosis in the left sacral ala with slight diastasis of the SI joint.”  Despite treatment, the back condition could not be adequately rehabilitated to meet the physical requirements of the CI’s continued training and the CI was referred for an MEB.  The MEB forwarded “posttraumatic arthrosis, left sacroiliac joint” for PEB adjudication.  

At the time of the sports medicine clinic appointment on 12 March 2002, the CI reported pain was improving.  Physical examination showed pain in the left SI joint, no deformity, no swelling.  There was tenderness to palpation, full active range of motion (ROM) and the CI had a mild limp.  The MEB NARSUM examination on 22 May 2002, 3 months prior to separation, noted complaints of left sacroiliac joint area pain that caused him to walk with a limp and prevented him from participating in strenuous, weight bearing activities, such as running, jumping, climbing, or prolonged standing.  Physical examination showed that the CI walked with a left antalgic gait, and tenderness along the region of the left sacroiliac joint.  The examination did not address ROM measurements.  During the MEB examination (recorded on DD Forms 2807 and 2808) dated 4 June 2002, 2 months prior to separation, the CI reported recurrent back pain.  Physical examination showed pain with full flexion in the CI’s hips, normal reflexes, normal sensation, normal strength, and the CI was able to heel to toe walk with pain.  The examiner noted that the CI walked with a limp and had spasms.  

At the 2 July 2002 VA Compensation and Pension (C&P) evaluation, performed 1 month before separation, the CI reported that his injury had improved only a maximum of 10-20%.  Physical examination showed a normal posture and gait, and the examiner noted that the musculoskeletal “is entirely normal with the exception of tenderness over the left sacroiliac area.  There is no evidence of swelling, effusion, muscle spasm, or joint laxity.”  Neurologic examination showed no abnormalities of gait, stance, or coordination.  Cranial nerves were intact.  Deep tendon reflexes were equal and physiologic.  

In accordance with DoDI 6040.44, the Board is required to recommend a rating IAW the VASRD in effect at the time of separation.  The Board noted that the 2002 VASRD standards for the spine, which were in effect at the time of separation, were changed effective 23 September 2003, and then to the current §4.71a rating standards effective 26 September 2003.  The Board must correlate the above clinical data with the 2001 rating schedule; applicable diagnostic codes include: 5292 (limitation of lumbar spine motion); 5293 (intervertebral disc syndrome); and 5295 (lumbosacral strain).  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back condition 10%, analogously coded 5295 (lumbosacral strain).  The VA rated the low back condition 10%, coded 5294 (sacroiliac injury) based on the VA C&P examination 1 month before separation, citing treatment and diagnosis of chronic SI dysfunction. Although there was insufficient limitation of motion of the lumbar spine or hip to support a minimum rating, the Board agreed a 10% rating was justified for the presence of painful motion and tenderness.  There was no abnormal mobility on forced motion or muscle spasm on extreme forward bending, thus the next higher 20% rating was not justified on this basis.  There was no evidence of intervertebral disc syndrome with persistent symptoms compatible with sciatic neuropathy for alternative coding under 5293 (intervertebral disc syndrome) and there was no evidence of an associated unfitting radiculopathy for consideration of a separate peripheral nerve rating.  The Board’s rating recommendation is for the low back pain and sacroiliac dysfunction together IAW VASRD §4.66 (sacroiliac joint) which stipulates “the lumbosacral and sacroiliac joints should be considered as one anatomical segment for rating purposes.”  The Board concluded there was no evidence to support a rating higher than the rating adjudicated by the PEB.  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 posttraumatic arthrosis, left sacroiliac joint condition.  

BOARD FINDINGS:  In the matter of the posttraumatic arthrosis, left sacroiliac joint 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 

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150624, 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 15 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:

		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USMC

						  XXXXXXXXXXXXXXXXXXX
	     				  Assistant General Counsel
						  (Manpower & Reserve Affairs)