RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01825
BRANCH OF SERVICE:  Marine Corps 	SEPARATION DATE:  20080715

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E1, Officer Candidate – PLC Law Program, medically separated for “degenerative disk disease with multi-level herniated disks,” with a disability rating of 10%.

CI CONTENTION:  “Review all conditions.”   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 - 20080506	VARD – N/A	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Degenerative Disc Disease with Multi-Level Herniated Discs	5237	10%	No VA Examination in Evidence	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  N/A	

ANALYSIS SUMMARY:  

Degenerative Disc Disease with Multi-Level Herniated Discs.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s low back pain (LBP) condition began in July 2006 subsequent to an injury he incurred during Marine Corps Officer Candidacy School training.  An MRI diagnostic study of the lumbar spine in August 2006 is reported to have demonstrated herniated discs at L4-5 and L5-S1.  Subsequent to this finding the CI underwent an epidural steroid injections of the lumbar spine in October 2006.  Despite treatment, the LBP 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 “lumbago” and “degeneration of intervertebral disc, site unspecified” for PEB adjudication.  
The 1 August 2007 family practice (FP) clinic evaluation, 11 months prior to separation, stated the CI had previously undergone the above referenced epidural injections with pain improved from this procedure and that his pain was 1/10 with prolonged sitting or driving.  The CI was unable to run or jog, but performed cardiovascular exercise through an elliptical machine and stationary bicycle.  The CI’s lower back pain was occasionally present upon awakening, was chronic in nature and did not radiate.  Physical examination showed the CI was able to stand erect.  The CI had full forward flexion and extension.  There was painful motion in the left lower back with lateral flexion.  The lumbosacral spine had normal spine curvature and there were no muscle spasms present.  Bilateral rotation showed no painful motion.  Straight leg testing was negative.  

At the 10 October 2007 FP clinic examination, 9 months prior to separation, the CI reported he was “feeling pretty good”.  He was doing limited lifting, cardiovascular exercise and yoga.  The CI had no weakness, numbness or paresthesias in the lower extremities.  There was no loss of bowel or bladder function.  Pain was reported as 1/10 with prolonged sitting/driving.  Pain increased to 3-4/10 if the CI did not perform stretching.  Physical examination showed no redness or swelling with 5/5 muscle strength in the lower extremities.  The CI was neurovascularly intact.  There was no tenderness to palpation along the spine.  

At the MEB NARSUM examination, written on 7 November 2007 from 1 August 2007 FP clinic note, provides no additional ratable information.  There was no VA Compensation and Pension examination in evidence proximate to separation.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back condition 10%, coded 5237 (lumbosacral strain).  Although there was insufficient limitation of motion to support a minimum rating, the panel agreed a 10% rating was justified IAW VASRD §4.59 for the presence of painful motion.  There was no muscle spasm or guarding severe enough to result in an abnormal gait or spinal contour, thus the next higher 20% rating was not justified on this basis.  While the initial episode of back pain was reported to have been an episode of intervertebral disc syndrome (IVDS) with a single incapacitating episode, there was no objective documentation of additional episodes of incapacitating IVDS in the 12 months prior to separation which would provide for a higher rating under that formula (for IVDS), or evidence of ratable peripheral nerve impairment which would provide for additional ratings.  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 degenerative disc disease with multi-level herniated discs condition.    

BOARD FINDINGS:  In the matter of the degenerative disc disease with multi-level herniated discs 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 re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated, w/atchs
Exhibit B.  Service 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 USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC

	
						 XXXXXXXXXXXXXXXXXX