RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2016-00394
BRANCH OF SERVICE:  marine coRps	SEPARATION DATE:  20050603

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a Reserve E3, AntiTank/Assault Guided Missile Man, medically separated for “lumbago” 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 Medical Evaluation Board (MEB), but determined by the PEB 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.  The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence relevant to application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards for 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, which operates 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 disability at the time of separation.

RATING COMPARISON:

SERVICE PEB - 20050513	VARD - 20060907	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Lumbago	5237	10%	Intervertebral Disc Syndrome	5243	20%	20060726	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:

Lumbago.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s back condition began approximately in June 2004 after jumping off an 8- foot transformer while on active duty for an exercise.  Conservative therapy did not ameliorate his condition, and an MRI on 13 July 2014 demonstrated degenerative/traumatic changes at L4-L5 and L5-S1 with a central disk extrusion at L4-5 causing a mild spinal stenosis.  At a neurosurgical visit on 22 September 2004, the examiner noted the CI’s range of motion (ROM) for flexion was approximately “75% of normal,” and continued conservative therapy was recommended.  At a follow-up on 1 December 2004, the neurologist recorded “full” back ROM and opined that the CI would not likely benefit from surgical intervention at that time.  
During the 11 March 2005 MEB NARSUM examination, 3 months prior to separation, the CI complained of back pain.  Physical examination referred to neurosurgical findings on 18 January 2005, which revealed flexion to approximately 50 degrees (normal 90), minus 5 degrees of extension, and about 25 degrees of right and left lateral bending, all with pain.  The CI had a normal gait and motor strength with decreased light touch sensation in the right foot (L5 and S1 dermatomes) as compared to the left side.  Reflexes were 2+ and symmetric throughout the lower extremities.  Straight leg raising (to determine nerve root irritation) was negative.  The CI had mild bladder over activity, but no evidence of neurogenic bladder dysfunction.  

At the 26 July 2006 VA Compensation and Pension (C&P) examination, 14 months after separation, the CI reported back pain rated at 6/10.  Physical examination showed a normal gait, but abnormal posture.  While there was spinal tenderness, no muscle spasm was present.  Thoracolumbar ROM was flexion to 40 degrees and combined ROM was 130 degrees, with painful motion.  After repetition, ROM was reduced by 10 degrees due to pain (major functional impact), fatigue, weakness, and lack of endurance. 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, coded 5237 (lumbosacral strain).  The VA rated the back condition 20%, coded 5243 (intervertebral disc syndrome (IVDS)), based on the C&P examination, citing limitation of flexion greater than 30 degrees but not greater than 60 degrees.  Members agreed that a 20% rating, but no higher, was justified for limitation of flexion as reported on the MEB NARSUM and C&P examinations.  There was no documentation of IVDS with incapacitating episodes which would provide for a higher rating under that formula.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 20% for the back condition, coded 5237.

BOARD FINDINGS:  In the matter of the lumbago condition, the panel recommends a disability rating of 20%, coded 5237 IAW VASRD §4.71a.  There are no other conditions within the panel’s scope of review for consideration.

The panel recommends the CI’s prior determination be modified as follows, effective the date of medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	
Lumbago	5237	20%	

MEMORANDUM FOR DEPUTY COMMANDANT (Manpower and Reserve Affairs) COMMANDER, NAVY PERSONNEL COMMAND

Subj:	PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS

Ref:	(a)	DoDI	6040.44		
	(g)	PDBR	ltr dtd	21	Sep	18	ICO	XXXXXXXXXX		

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

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

3.	Please take action to implement these decisions and provide notification to the above individuals once those are complete.