From: To:

DEPARTMENT  OF  THE  NAVY
SECRETARY OF THE NAVY COUNCIL OF REVIEW BOARDS 720 KENNON STREET SE STE 309
WASHINGTON NAVY YARD, DC 20374

IN   REPLY   REFER  TO:
1850
CORB:003
20 Feb 20

Director, Secretary of the ·Navy Council of Review Boards 
PD-2017-00604

Subj:	PHYSICAL DISABILITY BOARD OF REVIEW (PDBR)

Ref:	(a) DoDI 6040.44
(b) PDBR ltr dtd 4 Feb 19

1.	Pursuant to reference (a), the PDBR reviewed your case and forwarded its recommendation (reference (b)) to the Department of the Navy.

2.	On 12 February 2020, the Assistant Secretary of the Navy (Manpower & Reserve Affairs) accepted the recommendation of the PDBR of no change to your characterization of separation or disability rating assigned by the Department of the Navy's Physical Evaluation Board.

3.	The Secretary's decision on your PDBR application is final and is not subject to appeal or additional review by the Board for Correction of Naval Records.

RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXX		CASE: PD-2017-00604 BRANCH OF SERVICE: MARINE CORPS	SEPARATION DATE: 20060915

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Motor Vehicle Operator, medically separated for “lumbar pain” with a disability rating of 20%.

CI CONTENTION: “Increase in Veteran disabilities and seriousness of service connected disabilities as well as some newly found service connected 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 - 20060915	VARD - 20070809	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Lumbar Pain	5237	20%	L5-S1 Disc Disease of the Lumbar Spine	5237	10%	20070104	
Sciatica	Cat II					
COMBINED RATING: 20%	COMBINED RATING OF ALL VA CONDITIONS: 30%	
	
ANALYSIS SUMMARY:

Lumbar Pain. According to the service treatment record and MEB narrative summary (NARSUM), the CI’s low back condition began in 2004 when he felt pain in his back and lower extremities (LEs) while picking up heavy equipment. Symptoms were exacerbated following a motor vehicle accident in March 2005. An MRI dated 12 October 2005 showed very mild L4-L5 and L5-S1 discogenic degenerative changes without significant spinal canal or neural foramen narrowing. Electrodiagnostic testing performed on 20 October 2005 revealed normal bilateral LEs and no

evidence of radiculopathy. Although treated with physical therapy and activity modification, the pain did not subside.

At a neurosurgery examination on 30 December 2005, 9 months before separation, the CI reported low back pain (LBP) radiating to the hips and legs. Physical examination showed moderate tenderness, no spasm, and straight leg raising test for radiculopathy was negative. Lumbar spine flexion was 50 degrees (normal 60), extension was 10 degrees (normal 30), and lateral flexion was 10 degrees (normal 30). Painful motion was not addressed. A CT scan of the lumbar spine dated 7 February 2006 showed minimal degenerative disc disease at L4-5 and L5- S1 along with a Schmorl’s node on the inferior endplate of L4. At a follow-up neurosurgical visit on 7 March 2006, the CI reported he received an epidural steroid injection that did not help. Lumbar flexion was 50 degrees with moderate tenderness. The examiner’s assessment was mechanical and discogenic LBP and L4/5 degenerative disc disease. The CI wanted to pursue surgical options so he could get “fixed.”

A trial of Lyrica (pregabalin for nerve pain) was recommended on 5 April 2006. Two days later the CI had a consultation with an orthopedic surgeon who noted trunk flexion was normal and recommended further imaging studies.  A whole body bone scan was normal on 24 April 2006.  A CT myelogram scan of the lumbar spine on 10 May 2006 showed minimal degenerative end plate changes present at T12/L1 with minimal anterior osteophyte formation and similar degenerative end plate changes along the anterior inferior aspect of L4 with very minimal posterior osteophyte formation and disc bulging at L4/5.

During the 7 July 2006 MEB NARSUM examination, 2 months prior to separation, the CI reported near constant, sharp, stabbing LBP that radiated to the bilateral LEs with intermittent numbness. The pain was aggravated by running, bending or prolonged sitting, standing or walking. Physical examination revealed normal bilateral LEs motor strength, “depressed” and symmetric reflexes, and intact sensation. Straight leg raise testing for radiculopathy was negative. Range of motion (ROM) of the “trunk” was flexion 45 degrees and combined ROM was 175 degrees (normal 240) with painful motion.

During the 4 January 2007 VA Compensation and Pension (C&P) examination, 4 months after separation, the CI reported constant, squeezing, aching, sharp and sticking LBP radiating to the bilateral LEs. Physical examination revealed a normal gait and posture without spinal tenderness, muscle spasm or radiating pain with movement. A straight leg raising test for radiculopathy was negative. Bilateral LEs motor function and sensation were within normal limits as were his reflexes. Thoracolumbar flexion was 85 degrees and combined ROM was 225 degrees. There was 10 degrees loss of ROM due to pain, but not due to weakness, incoordination, or lack of endurance after repetition.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the low back condition 20%, coded 5237 (lumbosacral strain). The PEB also listed “sciatica” as a related Category II condition that contributed to the primary unfitting condition but which was not separately ratable. The panel considered this impairment and agreed that although the CI reported radiating back pain into his bilateral LEs, the pain is subsumed under the general spine rating criteria, which specifically states “with or without symptoms such as pain (whether or not it radiates).” The panel agreed there was no objective evidence of a radiculopathy with functional impairment (such as weakness), nor performance-based evidence from the record that this condition significantly interfered with satisfactory duty performance at separation. The VA rated the low back condition 10%, also coded 5237, based on the C&P examination, citing limitation of flexion or combined ROM.

The panel agreed there was no limitation of thoracolumbar spine motion, proximate to separation, to support a rating higher than the 20% adjudicated by the PEB.   There was no

documentation of intervertebral disc syndrome with incapacitating episodes that 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 concluded there was insufficient cause to recommend a change in the PEB adjudication for the low back condition.

BOARD FINDINGS: In the matter of the low back condition and IAW VASRD §4.71a, the panel 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 20170214, w/atchs Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record