RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02449
BRANCH OF SERVICE:  Marine Corps 	SEPARATION DATE:  20020228

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Rifleman, medically separated for “lumbar degenerative disc disease,” with a disability rating of 10%.

CI CONTENTION:  The CI made no specific contention.  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 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 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 determinations 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 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 - 20020115	VARD - 20021003	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Lumbar Degenerative Disc Disease	5293	10%	Residuals, Degenerative Disc Disease of the Lumbar Spine	5293	20%	20020814	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Lumbar Degenerative Disc Disease.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI had low back pain (LBP) for about three years, which began without specific injury or trauma.  He again aggravated his back while on a unit run in July 2001.  Since that time his pain was constant.  MRI showed L4/L5 desiccation, and L3-S1 diffuse disc bulging without herniation.  Evaluation by neurosurgery concluded with a diagnosis of lumbar degenerative disc disease and offered three options; physical therapy/living with the pain, steroid injections for temporary relief, or spinal fusion surgery with the possibility of it leading to other complications and the need for additional spinal fusion surgeries.

The 22 October 2001 MEB NARSUM examination, 4 months prior to separation, noted complaints of low back pain with periodic exacerbations that usually lasted just a few days.  However, he had continuous pain for the previous three months since last hurting his back.  The pain was mostly in his lower back with some radiation down his lateral right thigh.  Physical examination showed motor strength was full in his lower extremities except for 4+/5 strength in his right quadriceps.  Sensation was intact in both lower extremities.  Reflexes were slightly decreased bilaterally in the knees and ankles.  

At the 14 August 2002 VA Compensation and Pension (C&P) evaluation, performed 7 months after separation, the CI reported persistent 6/10 low back pain now and kept him awake at night, aggravated by coughing and sneezing, radiating down his right leg, associated with numbness of the feet and the back of the legs.  Physical examination showed a normal gait.  He could hop on either foot, heel and toe walk, squat and rise.  While he was seated in a chair, he shifted his weight because of discomfort.  His forward flexion was 70 degrees, extension 25 degrees, lateral flexion 20 degrees on the right, and lateral flexion 25 degrees on the left.  Straight leg raising was positive on the right at 70 degrees, provoking low back pain.  There was sciatic notch tenderness, worse on the right, with bilateral paraspinal muscle spasms.  There was hypoesthesia of the dorsum of the right foot.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, coded 5293 (Intervertebral disc syndrome (IVDS)).  The VA rated the back condition 20% coded 5293 (IVDS), based on the VA C&P examination 7 months after separation, citing 70 degrees of flexion and 25 degrees of backward extension.  The panel agreed a moderate 20% rating, but no higher, was justified for IVDS (recurring attacks) reported on the STR, NARSUM, and C&P examinations.  There was no limitation of motion which supported a rating under the diagnostic codes for limitation of lumbar motion (5292).  The examinations proximate to separation did not demonstrate the presence of lumbar spine ankylosis (5289), and there was no history of vertebral fracture residuals (5285) to support a rating under the respective codes.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 20% for the lumbar degenerative disc disease condition, coded 5293.  

BOARD FINDINGS:  In the matter of the lumbar degenerative disc disease condition, the panel unanimously recommends a disability rating of 20%, coded 5293 IAW VASRD §4.71a.  There are no other conditions within the panel’s scope of review for consideration.  The panel 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	
Lumbar Degenerative Disc Disease	5293	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150823, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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

Ref:  (a) DoDI 6040.44
	(b) PDBR ltr dtd 07 Jul 17 XXXXXXXXXXXXXXXXXX
 
	(c) PDBR ltr dtd 31 Jul 17 XXXXXXXXXXXXXXXXXX

	(d) PDBR ltr dtd 31 Jul 17 XXXXXXXXXXXXXXXXXX

	(e) PDBR ltr dtd 31 Jul 17 XXXXXXXXXXXXXXXXXX

	(f) PDBR ltr dtd 03 Aug 17 XXXXXXXXXXXXXXXXXX

1.  Pursuant to reference (a), the recommendations of the Physical Disability Board of Review set forth in references (b) through (f) are approved.  The official records of the following individuals are to be corrected as follows:

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

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

     c. XXXXXXXXXXXXXXXXXX, former USN: 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 20 percent disability rating (increased from 10 percent) effective date of discharge.       

     e. XXXXXXXXXXXXXXXXXX, former USMC: Placement on the Permanent Disability Retired List with a 30 percent rating (increased from 0 percent) effective date of discharge.      
     
3.  Please take action to implement these decisions and provide notification to the above individuals once those actions are complete.

	XXXXXXXXXXXXXXXXXX

	Acting