RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXXX		CASE: PD-2017-01353 BRANCH OF SERVICE: MARINE CORPS	SEPARATION DATE: 20090330

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E2, Flight Equipment Technician, medically separated for “lower back pain” with a disability rating of 10%.

CI CONTENTION: “This issue is going to be a lifelong disability that continually causes discomfort. I believe that this issue will get worse as I get older and cause more problems down the road.” 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 - 20090210	VARD - 20090803	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Lower Back Pain	5237	10%	
Low Back with L4 Defect	
5237	
10%	
20090605	
Grade 1 L4-L5 Anterior Spondylolisthesis	Cat II					
L5-S1 Degenerative Disc Disease	Cat II					
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 10%	
	
ANALYSIS SUMMARY:

Lower Back Pain (LBP). According to the service treatment record and MEB narrative summary (NARSUM), the CI’s low back condition began in March 2007 after running during physical training. Treatment in April 2007 was with a nonsteroidal anti-inflammatory drug, a muscle relaxer, and back exercises. X-rays dated 12 April 2007 demonstrated a levoconvex curvature of the lumbar spine, 2-3 mm of anterior displacement of L4 upon L5, and an intervertebral disc

space loss at L5-S1. The radiologist’s impression was L5-S1 degenerative disc disease (DDD) and Grade I anterolisthesis. Chiropractic manipulation afforded no improvement. At an orthopedic clinic visit on 24 August 2007, examination revealed no evidence of significant scoliosis and no spinous process tenderness. Forward flexion was intact from finger tips to toes. He was noted not to be a surgical candidate for Grade 1 spondylolisthesis and was referred to physical therapy (PT). X-rays dated 24 August 2007 showed a right-sided L4 pars interarticularis defect. He was placed on limited duty on 14 September 2007 and underwent PT without response.

An MRI on 7 February 2008, 14 months prior to separation, revealed a normal lumbar spine, with the exception of L5-S1 mild posterior disc bulge, which caused minimal indentation of the thecal sac. There was no evidence of a herniated nucleus pulposus, central canal stenosis, or neural foraminal narrowing at all lumbar levels. On 2 April 2008 he had a lumbar epidural steroid injection with no improvement. A trial of Elavil (amitriptyline for nerve pain) likewise provided no improvement in the pain. At an emergency room (ER) visit on 9 August 2008, the CI received a narcotic, a muscle relaxer, and an oral steroid for an acute exacerbation of back pain. On 1 October 2008 the CI was placed on limited duty for a second time.

At the time of the primary care clinic on 24 November 2008, 4 months prior to separation, the CI reported chronic LBP with symptoms which worsened over the past day. On examination the CI gait and posture were normal. The lumbosacral spine exhibited muscle spasms over the left lumbar paraspinal muscles. Lumbosacral spine range of motion (ROM) measured in degrees showed flexion and extension of 45 (normal 90 and 30), and left and right lateral flexion of 45 bilaterally (normal 30). Painful motion was noted. Straight leg raise (SLR) testing to determine nerve root irritation was negative and the lumbar/lumbosacral spine exhibited no abnormalities. Pain medications were held. The CI was seen later in the day in the ER where he received pain medication (Ultram (tramadol, an opioid-like medication) and a muscle relaxer.

The 4 December 2008 MEB NARSUM examination noted complaints of LBP that limited his ability to run, walk and carry heavy items. Physical examination showed the CI walked with a normal gait and an SLR test was negative bilaterally. The lumbosacral spine exhibited tenderness on the lumbar paraspinals bilaterally at L4-L5 and ROM was full, except for slight decrease with flexion; pain was elicited by flexion and extension.

At the 5 June 2009 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported constant LBP every day, which he described as a tight feeling. There was no radiation of pain and no leg numbness. He had no additional limitations with flare-ups and the pain didn’t interfere with daily activities except with running for long periods of time. He stated he had zero incapacitating episodes in the past year. Physical examination showed the CI walked with a normal gait and had a normal curvature of the lumbar spine that was non-tender, with no deformities o swelling. There was no muscle atrophy or muscle spasm present and deep tendon reflexes were 1+ and equal in the lower extremities. Muscle strength and an SLR test were normal. Lumbar spine flexion was 100 degrees with combined ROM of 230 degrees (normal 240). Pain was not elicited with motion.

The panel directed attention to its rating recommendation based on the above evidence. The PEB and VA rated the low back condition 10%, coded 5237 (lumbosacral strain). The VA rating was based on the C&P examination, citing decreased ROM. The Navy PEB also listed Grade 1 L4- L5 anterior spondylolisthesis and L5-S1 DDD as related Category II conditions (contributed to the primary unfitting condition but were not separately ratable). The impairment from the spondylolisthesis and DDD were properly subsumed under the overall rating for the low back condition IAW §4.14 (avoidance of pyramiding; more than one rating based on the same impairment is prohibited).

The panel agreed that a 10% rating, but no higher, was justified for the presence of painful motion at the NARSUM examination and for limitation of combined ROM (greater than 120 degrees but not greater than 235 degrees) as reported on the VA C&P examination 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. 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.

DEPARTMENT OF THE NAVY
SECRETARY OF THE NAVY COUNCIL OF REVIEW BOARDS 720 KENNON STREET SE STE 309
WASHINGTON NAVY YARD, DC 20374-5023

IN   REPLY   REFER  TO:
1850
CORB: 003 20May20

From: 

Director, Secretary of the Navy Council of Review Boards 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR)

Ref:	(a) DoDI 6040.44
(b) PDBR ltr dtd 21 Apr 19

1.	Pursuant to reference (a), the PDBR reviewed your case and forwarded its recommendation (reference (b)) to the Department of the Navy on 5 Mar 2020 for appropriate action.

2.	On 20 March 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.