RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00792
BRANCH OF SERVICE:  MARINE CORPS	SEPARATION DATE:  20040920

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a Reserve E5, Motor Vehicle Operator, medically separated for “back pain” with a disability rating of 20%.  

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 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 - 20040520	VARD - 20041227	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Back Pain	5237	20%	Low Back Strain With Radiculopathy	5243	40%	20041004	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  50% 	

ANALYSIS SUMMARY:  

Back Pain.  According to the service treatment record and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s back condition began in March 2003 with no reported trauma.  He later aggravated it in June 2003 during a training exercise carrying another Marine.  Lumbar spine MRI studies on 8 September 2003 showed normal alignment with no lumbar disc herniation or significant central canal or neuroforaminal stenosis.  

During a 14 January 2004 pain management appointment, the CI complained of upper and lower back pain across the whole back and down the right leg, which was aggravated by moving and twisting.  MRI studies showed a normal lumbar spine with “tightness at L4-L5 that may be pinching the nerve just slightly.”  The examiner noted gait, including heel and toe walk, within normal limits, and no atrophy.  Range of motion (ROM) was forward flexion to 70 degrees (normal 90), and extension to 5-7 degrees (normal 30) with pain.  The 23 February 2004 MEB NARSUM examination, 7 months prior to separation, noted CI complaints of a constant, dull ache in the low back.  Physical examination showed tenderness in the mid-shoulder blade and mid-lumbar areas.  

At the 4 October 2004 VA Compensation and Pension (C&P) evaluation, 1 month after separation, the CI reported daily, warm, aching pain in his lower back which turned into stabbing pain and occasionally radiated into the posterior right leg to the knee.  He recently underwent three epidural steroid injections which did not improve his symptoms.  Since the onset of symptoms, he described “a couple” of episodes that required complete bedrest for a single day.  Physical examination showed a guarded gait.  Thoracolumbar ROM was flexion to 65 degrees and combined ROM of 185 degrees (normal 240) with painful motion during repetitive movement.  The examiner estimated an additional functional loss of 50% after repetitive motion without providing measurements or rationale.  Tenderness was observed without mention of spasms, and spinal contours were normal.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 20%, coded 5237 (lumbosacral strain).  The VA rated the back condition 40%, coded 5243 (intervertebral disc syndrome), based on the C&P examination a month after separation, citing limitation of forward flexion and included the estimate of an additional 50% loss in ROM with repetition.  There was no evidence of thoracolumbar spine forward flexion of 30 degrees or less to support a 40% rating under the general rating formula for diseases and injuries of the spine.  There was no evidence of intervertebral disc syndrome which resulted in incapacitating episodes requiring physician-prescribed bed rest to warrant consideration of 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 that there was insufficient cause to recommend a change in the PEB adjudication for the back pain condition.  

BOARD FINDINGS:  In the matter of the back pain 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 20160917, 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 USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN