RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01468
BRANCH OF SERVICE:  MARINE CORPS	SEPARATION DATE:  20060531

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Supply Administration and Operations Clerk, medically separated for “chronic right greater trochanteric bursitis” with a disability rating of 10%.

CI CONTENTION:  Additional unfitting conditions (mental health, bilateral knees, bilateral hips, pelvic pain, and bilateral feet) were not evaluated.  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 - 20060320	VARD - 20061226	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Right Greater Trochanteric Bursitis	5299-5003	10%	Lower Right Extremity Radiculopathy (Claimed as Right Greater Trochanteric Bursitis)	8520	10%	
20061019
	
Moderate Degenerative Disk Disease at L4-L5 and L5-S1	Category II					
Chronic Low Back Pain with Radiculopathy	Category III	Lumbar Spine with Disc Bulge and  DDD	5237	10%	20061016	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:

Chronic Right Greater Trochanteric Bursitis.  According to the service treatment record and MEB narrative summary (NARSUM), the CI reported a 6-year history of chronic right hip pain.  X-rays and an MRI revealed a normal right hip, and she was treated by neurosurgery, physical therapy and pain management specialists.  The CI completed two 6-month limited duty periods without symptom resolution; no surgery was indicated.  The 3 February 2006 MEB NARSUM examination, 4 months prior to separation, noted complaints of chronic right hip pain for 6 years causing an inability to run.  Physical examination revealed normal posture and gait, right hip flexion to 130 degrees (normal 125) with pain, and external rotation to 55 degrees (normal 45).  

At the 16 October 2006 VA Compensation and Pension (C&P) spine evaluation, 5 months after separation, the CI complained of right hip pain associated with low back pain (LBP).  Physical examination showed no tenderness and ROM measurements, in degrees, showed flexion to 120,  extension to 30 (normal 20), adduction to 20 (normal 45), abduction to 45 (normal), external rotation to 60 , and internal rotation to 40.  The examiner noted that the CI’s range of motion (ROM) was not limited by pain.  During the 19 October 2004 VA (C&P) general evaluation, the CI reported right hip pain starting in 2005.  Physical examination showed full right hip ROM.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right hip condition 10%, analogously coded 5299-5003 (arthritis, degenerative).  The Navy PEB also listed moderate degenerative disk disease (DDD) at L4-L5 and L5-S1 as a related Category II condition (contributes to the primary unfitting condition but not separately ratable).  The VA rated the right lower extremity radiculopathy (claimed as chronic right greater trochanteric bursitis) 10%, coded 8520 (sciatic nerve, paralysis of knee and/or feet), based on the C&P evaluations, citing a mild-incomplete paralysis below the knee.  Members agreed that right hip limitation of motion did not meet any higher rating criteria and evidence of painful motion warranted a 10% rating.  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 right hip condition.  

Contended PEB Conditions:  Moderate Degenerative Disk Disease at L4-L5 and L5-S1; and Chronic LBP with Radiculopathy.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  As noted above, the PEB listed moderate DDD at L4-L5 and L5-S1 as a related Category II condition.  Additionally, chronic LBP with radiculopathy was listed as a Category III condition (not separately unfitting and does not contribute to the unfitting condition).  A lumbar spine MRI on 11 January 2005 showed bulging of the L5-S1 and of the L4-L5 intervertebral disks, and a tiny central protrusion of the disk material of L4-L5 measuring 1-2mm.  Electrodiagnostic studies on 17 March 2005 were negative for radiculopathy.  The 15 May 2005 physical therapy evaluation documented normal ROM and the 3 February 2006 MEB NARSUM examination recorded complaints of chronic LBP.  Two 6-month limited duty periods and a series of three lumbar epidural steroid injections at L5-S1 did not improve symptoms.  The NARSUM examiner stated the continued LBP prohibited the CI from performing her duties, and the 9 February 2006 medical board notification imposed limitations to include no physical fitness training or testing, no running, no heavy lifting, no prolonged walking, standing, crawling or jumping, and no deployments.  The 13 February 2006 non-medical assessment did not support retention.  Members agreed that the back condition was separate and distinct from the trochanteric bursitis and concluded that, by a preponderance of evidence, the DDD was unfitting and warranted a separate rating.  The impairment from the chronic LBP was subsumed under the overall rating IAW §4.14 (avoidance of pyramiding; more than one rating based on the same impairment is prohibited).  
  
The panel next considered its rating recommendation and noted that the 21 February 2006 MEB examination (recorded on DD Forms 2807 and 2808), 3 months prior to separation showed tenderness over the right L4-L5 paraspinal muscle.  The 16 October 2006 VA C&P evaluation noted complaints of LBP, with forward flexion to 85 degrees (normal 90) and a combined ROM of 185 degrees (normal 240) with pain.  Lower extremity strength, sensation and reflexes were normal.  The panel agreed that a 10% rating, but no higher, was justified for limitation of flexion (greater than 60 degrees but not greater than 85 degrees) and combined ROM (greater than 120 degrees but not greater than 235 degrees), as reported on the VA evaluation proximate to separation.  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.  

The panel next considered if an additional disability rating was justified for peripheral nerve impairment due to radiculopathy.  The CI had a broad based disk bulging at L4-L5 without evidence of herniation and there were symptoms of radiating pain documented in the treatment records; however, examinations indicated normal strength, reflexes and gait, and sensation was intact.  Members agreed there was no associated radiculopathy for a separate peripheral nerve rating.  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).”  There was no objective evidence of a radiculopathy with functional impairment (such as weakness) that directly impacted fitness for duty.  The panel therefore concluded that an additional disability rating was not justified on this basis.  After due deliberation, the panel agreed that the preponderance of the evidence with regard to the functional impairment of the low back condition favors its recommendation as an additionally unfitting condition for disability rating.  It is appropriately coded 5242 and meets the VASRD §4.71a criteria for a 10% rating based on limited painful motion.  

BOARD FINDINGS:  In the matter of the right hip condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the moderate DDD, the panel recommends a disability rating of 10%, coded 5242 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	
Chronic Right Greater Trochanteric Bursitis	5299-5003	10%	
Moderate Degenerative Disk Disease at L4-L5 and L5-S1	5242	10%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20161012, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

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

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

a.	XXXXXXXXXXXXXXXXXX, former USN: Placement on the Permanent Disability Retired List with a 30 percent 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 USMC: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge.

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

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

g.	XXXXXXXXXXXXXXXXXX, 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 thoseact