RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00499
BRANCH OF SERVICE:  MARINE CORPS 	SEPARATION DATE:  20060630

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E7, Aviation Supply Specialist, medically separated for “chronic low back pain” with a disability rating of 10%.  

CI CONTENTION:  She has two back issues and still has problems with them but was only rated for one.  She also contends issues with bilateral carpal tunnel syndrome and fallen arches, which were not conditions identified by the MEB or PEB.  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 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.  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 - 20060215	VARD - 20070723	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain (LBP)	5237	10%	Unilateral Spondylolysis, Left-Sided, with Mild Spondylolisthesis, Grade 1; Sacroiliac Joint Arthritis with Left Hip Pain	5253-5239	10%	20060819	
Unilateral Spondylolysis, Left-Sided, with Mild Spondylolisthesis (Grade 1)	Cat II					
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:  

Chronic LBP.  According to the service treatment record and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s back condition began in approximately 2000 after a rear-end motor vehicle crash.  An MRI conducted on 1 December 2003 showed mild to moderate degenerative changes within the lower lumbar spine with minimal disc bulging at the L5-S1 level and narrowing of both neural foramina at that level.  A second MRI on 2 February 2005 demonstrated a broad based disc bulge at L5-S1 without central stenosis, lateral recess or neuroforaminal narrowing.  There was no surgical indication.  

The 21 December 2005 MEB NARSUM examination, 6 months prior to separation, noted complaints of chronic LBP, worse on the left side.  Physical examination showed “essentially full range of motion including flexion, extension, lateral bending and rotation.”  There was no scoliosis or palpable muscle spasm, but tenderness was reported over the sacroiliac joint.  An abnormal gait was not noted.  Tenderness was also recorded 2 weeks later during the 6 January 2006 MEB examination (recorded on DD Forms 2807-1 and 2808).  The examiner noted decreased range of motion (ROM) but did not provide specific measurements.  

At the 19 August 2006 VA Compensation and Pension (C&P) spine evaluation, 2 months after separation, the CI complained of left hip pain.  The examiner did not report any findings on the CI’s LBP, but did note an antalgic gait and painful motion of the left hip.  At the 21 August 2006 C&P general medical examination 2 days later, a different examiner noted a normal gait and spine.  The 22 August 2006 VA C&P foot examination also noted a normal gait.  

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 PEB also listed “unilateral spondylolysis, left-sided, with mild spondylolisthesis (Grade 1)” as a related Category II condition (contributed to the primary unfitting condition but was not separately ratable).  The impairment from the unilateral spondylolysis with left sided spondylolisthesis was properly subsumed under the overall rating for the back condition IAW §4.14 (avoidance of pyramiding; more than one rating based on the same impairment is prohibited).  The VA rated the back condition 10%, dual coded 5253-5239, (impairment of the thigh-spondylolisthesis or segmental instability), based on the C&P examinations 2 months after separation, citing painful motion of the left hip.  

Although there was insufficient limitation of motion to support a 10% rating, the panel agreed a 10% rating was justified for the presence of painful motion and tenderness.  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.  There was no documentation of intervertebral disc syndrome with incapacitating episodes which would provide for a higher rating under that formula.  While the CI may have experienced radiating pain from the back condition, this is subsumed under the general spine rating criteria, which specifically states “with or without symptoms such as pain (whether or not it radiates).”  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the back condition.  

BOARD FINDINGS:  In the matter of the back 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.  Therefore, the panel recommends 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 20160811, 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 USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC