RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01831
BRANCH OF SERVICE:  marine corps 	SEPARATION DATE:  20020930

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Helicopter Airframes Mechanic, medically separated for “chronic lumbar pain with sciatica,” rated 10% and 10%, respectively, with a combined disability rating of 20%.

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 - 20020807	VARD - 20030410	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Lumbar Pain	5295	10%	Lumbar Strain…	5299-5292	20%	20020228	
Sciatica	5295-8520	10%	Radiculopathy, Right Lower Extremity	8599-8521	10%	20020228	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

Chronic Lumbar Pain.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI developed chronic lumbar pain after falling in the barracks.  In June 1998 he developed a herniated disc and underwent micro discectomy.  Progressive back pain led to an L5-S1 fusion in June 2000 and a second instrument fusion at L5-S1 in November 2001.  He had persistent lumbar pain, although the fusion was solid and in good position.   

At the 28 February 2002 VA Compensation and Pension (C&P) evaluation, 7 months before separation, the CI reported return of the lumbar pain.  Physical examination showed three healed scars that matched the surgical sites.  He walked well and could heel and toe walk and squat.  He had limited motion of the lumbar spine with flexion of 42 degrees (normal 90) and extension 21 degrees (normal 30) with combined range of motion (ROM) of 173 degrees (normal 240).  There was pain on motion.  

The 9 May 2002 MEB NARSUM examination, 5 months prior to separation, noted improvement but the pain was aggravated by sit-ups and running, which caused pain that could last for days.  The pain was tolerable if he used an elliptical trainer instead of jogging.  Position changes also aggravated the pain.  He was taking no medications.  With low impact activities, his condition was tolerable and pain was the limiting factor.  There were no ROM measurements.  Physical examination showed the CI was able to walk without difficulty and motor strength was 5/5.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, coded 5295 (lumbosacral strain).  The VA rated the back condition 20%, coded 5299-5292 (analogous to moderate limitation of motion of the lumbar spine.), based on the C&P examination 7 months before separation, citing moderate limitation of motion. 

The separation date of August 2002 resulted in the PEB rating the low back condition according to the old spine rules. The panel agreed that criteria supporting a rating higher than 10% under the 5295 code were not in evidence (i.e. “with muscle spasm on extreme forward bending, loss of lateral spine motion, unilateral, in standing position”) during the NARSUM examination; but debated if a higher rating is supported under other codes in effect at the time of separation.  Under the 5292 code a 20% rating is justified for “moderate” limitation of lumbar motion, but based on the evidence at hand panel members concluded that this degree of limitation was not present.  Likewise, there was no evidence of incapacitating episodes to warrant a minimal rating under the 5293 code.  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.  

Sciatica.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI presented with right S1 radiculopathy in association with the fall described above.  He reported pain in the right buttock and right sacral iliac area with pain that migrated up and down the right thigh down into the foot with numbness and tingling in the lateral three toes.  After the first two surgeries, he had persistent right-sided facet pain including S1 radiculopathy.  After a second instrument fusion, the CI had episodes of sciatica with twitching in the right lower extremity.  The area was noted primarily in the right gastrocnemius muscle.  Electromyelogram (EMG), 6 months prior to separation, showed no ongoing denervation and no acute demyelination.  

At the 28 February 2002 VA Compensation and Pension (C&P) evaluation, 7 months before separation, the CI reported numbness in the right lateral toes with pain.  Physical examination showed decrease in sensation on the lateral aspect of the right leg (thigh, calf and foot.)  There was marked decrease of sensation of the lateral three toes with an inability to distinguish sharp and dull.  There was atrophy on the right side and weakness on the right lower extremity.  The right side was 57 cm in circumference and the left 59 cm.  

The 9 May 2002 MEB NARSUM examination, 5 months prior to separation, noted complaints of infrequent episodes of spasm in the calf.  The fasciculation and spasms appeared to occur mostly at night.  He had a history of dysesthesias (abnormal sensations) in the S1 distribution but this had become occasional.  He reported no complaint of clicking or catching painful sensation in the right lumbar spine.  It was greatly improved.  He was taking no medications.  There was no bowel or bladder dysfunction.  Physical examination showed symmetrical reflexes and no signs of myelopathy.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the sciatica condition 10%, coded 5295-8520 (incomplete paralysis of the sciatic nerve associated with lumbosacral strain).  The VA rated the right lower extremity radiculopathy 10%, coded 8599-8521 (analogous to incomplete paralysis of the common peroneal nerve), based on the C&P examination 7 months before separation, citing decreased sensation on the lateral aspect of the right thigh, calf and foot.

The NARSUM noted a normal EMG and the abnormal sensations in the S1 distribution had become occasional.  He was taking no medications.  Panel members concluded the symptoms of radiculopathy had improved and were infrequent and therefore, did not rise to the level of a moderate disability, rated 20%.  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 right lower extremity radiculopathy.  

BOARD FINDINGS:  In the matter of the back condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the right lower extremity radiculopathy and IAW VASRD §4.124a, 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 20150630, 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 USMC
		- XXXXXXXXXXXXXXXXXX, USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
	 	- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC

		
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