RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:	CASE: PD-2017-02323
BRANCH OF SERVICE: MARINE CORPS	SEPARATION DATE: 20090130

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Rifleman, medically separated for “lumbar degenerative disc disease [DDD]” and “chronic left knee pain,” each rated 10%, with a combined disability rating of 20%.

CI CONTENTION: Review all 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 - 20081030	VARD - 20090324	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Lumbar DDD	5239-5343	10%	Lumbar Disc Disease with L-5 Spondylolysis, Chronic Low Back Pain; and Grade 1 Spondylolisthesis	
5239	
10%	

20080612	
L5 Spondylolysis	Cat II					
Chronic Low Back Pain	Cat II					
Grade I Spondylolisthesis, L5 - S1	Cat II					
Sciatica	Cat II	Sciatica Lower Left Extremity	5299-8520	10%		
Chronic Left Knee Pain Due to Osteoarthropathy and Meniscal Tear	5260-5014	10%	Chronic Left Knee Pain Due to Arthropathy and Meniscal Tear	5260-5014	10%		
Right Knee Osteoarthropathy	Cat III	Right Knee
Osteoarthropathy	5260-5014	0%		
Neurodermatitis	Cat III	Neurodermatitis	7899-7806	0%		
Seasonal Allergic Rhinitis	Cat III	Seasonal Allergic Rhinitis	6522	10%		
Left Ulnar Neuropathy	Cat III	Left Ulnar Neuropathy	8599-8515	10%		
COMBINED RATING: 20%	COMBINED RATING OF ALL VA CONDITIONS: 40%	

ANALYSIS SUMMARY:

Lumbar DDD. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s back condition began in 2006 after falling down stairs during a nighttime combat simulation. In early 2007, he sought care for ongoing back pain, and a lumbar MRI showed: a left paracentral disc herniation with impingement on the left exiting L4 and traversing L5 nerve roots; and bilateral L5 spondylolysis (break in the bony articulation between the L5 and S1 vertebrae) with mild anterolithesis (anterior slippage) of L5 on S1. A neurosurgical consult on 19 March 2007 did not recommend surgery at the time. Anti-inflammatory medication and physical therapy were prescribed and the CI was referred to pain management. He received several nerve blocks, and on 27 September 2007, he underwent percutaneous disc decompression at L4-5 and L5-S1, which provided only temporary relief.

The 20 March 2008 MEB NARSUM examination, 10 months prior to separation, noted complaints of continued back pain that extended to the left buttocks, posterior thigh and sometimes the anterior leg, with numbness of the lateral three toes at times. Running or jogging worsened the pain, and the CI was unable to do sit-ups, push-ups, dig or wear body armor and needed to change positions frequently. Physical examination showed a normal gait and spinal alignment with no tenderness. Straight leg raise (SLR) testing to elicit radicular symptoms caused back pain at 90 degrees. Measured thoracolumbar ROM showed active flexion to 90 degrees (normal) and a combined range of motion (ROM) of 240 degrees (normal) after repetition. Lower extremity strength and reflexes were normal with decreased sensation over the lateral three toes.

At the 12 June 2008 VA Compensation and Pension (C&P) examination, 8 months before separation, the CI reported back pain. Physical examination showed tenderness at L5-S1, but no evidence of spinal ankylosis, and a negative SLR test. After repetition, active thoracolumbar flexion was to 90 degrees and combined ROM was 240 degrees, with pain at limits of all motion. Left lower extremity strength and reflexes were normal, and sensation was decreased on the top and bottom of the left foot in the L5 distribution. A lumbar MRI on 5 February 2008 showed slight interval regression of the disc protrusion at L4-5, with possible continued impingement of the L5 nerve roots. There was lower level lumbar arthropathy and no change in the spondylolysis/spondylolisthesis at L5-S1.

The panel directed attention to its rating recommendation based on the above evidence. This case was processed as part of the Joint DoD/VA Disability Evaluation Pilot Program. The PEB rated the back condition 10%, dual coded 5239-5243 (spondylolisthesis-intervertebral disc syndrome (IVDS)), as proposed by the VA, but also included sciatica as a contributing Category II condition. (The panel noted an apparent typographical error in the PEB code of 5239-5343 as 5243 is the VASRD spine code for DDD/IVDS and there is no VASRD 5343 code). The PEB also listed L5 spondylolysis, chronic low back pain, and Grade I L5-S1 spondylolisthesis as Category II diagnoses contributing to the disability in this case, as did the VA. Panel members concluded that these conditions could be reasonably justified as separately unfitting; nor would separate ratings be achievable without violation of VASRD §4.14 (avoidance of pyramiding). Regarding the sciatica, members concluded that a preponderance of evidence indicates the condition was not justified as separately unfitting given the normal lower extremity strength and reflexes noted at the VA examination, which was the most proximate examination to separation. There was also no evidence that the documented decreased sensation of the left foot impacted the CI’s duty performance. The VA rated the back condition 10%, coded 5239 (spondylolisthesis), based on the C&P examination.

Although there was insufficient limitation of motion to support a 10% rating, panel members agreed a 10% rating was justified for the presence of painful motion and tenderness noted at the VA examination. 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 evidence of IVDS which resulted in incapacitating episodes requiring physician-prescribed bed rest to warrant consideration of 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 back condition.

Chronic Left Knee Pain. According to the STR and MEB NARSUM, the CI underwent a partial left knee meniscectomy in 2007. Following surgery, the knee no longer locked, but pain continued. The MEB NARSUM examination noted complaints of left knee pain. Physical examination showed no effusion or synovitis, normal knee alignment and patellar tracking, and no evidence of pain with patellofemoral compression. There were no signs of instability or meniscal pathology, but vigorous manipulation of the left knee was painful. Following repetitive movement, knee flexion was to 145 degrees (normal 140) and extension to 0 degrees (normal). There was no additional functional loss due to pain, flare-ups, weakened movement, excess fatigability or incoordination.

At the C&P examination, the CI reported constant left knee pain. Physical examination showed medial joint line tenderness and positive testing for meniscal pathology (McMurray’s), but no laxity or abnormal motion. Flexion was to 140 degrees and extension to 0 degrees, with pain occurring at limits of motion. Knee X-rays showed medial joint space narrowing.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the left knee condition 10% as proposed by the VA, dual coded 5260-5014 (leg, limitation of flexion of-osteomalacia), for painful or limited motion of a major joint or group of minor joints. Panel members agreed that while there was no compensable limitation of flexion or extension (5260, 5261), there was evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45), as recorded at the MEB NARSUM and VA examinations. Although code 5259 (cartilage, semilunar, removal of, symptomatic) was applicable in this case, the maximum 10% rating under that code provided no benefit to the CI. There was no history or evidence of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258); and no fracture, nonunion or malunion of the femur or tibia to support consideration under the respective codes for knee impairment related to long bone conditions (5255, 5262). There was therefore no higher than a 10% rating supported under any applicable VASRD §4.71a code. 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 knee condition.

Contended PEB Conditions: Right Knee Osteoarthropathy, Neurodermatitis, Seasonal Allergic Rhinitis and Left Ulnar Neuropathy. The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting. The contended conditions were not noted on limited duty forms, implicated in the non-medical assessment, and did not fail retention standards. There was no performance-based evidence from the record that any of the conditions significantly interfered with satisfactory duty performance at separation. After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions, so no additional disability ratings are recommended.

BOARD FINDINGS: In the matter of the low back condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication. In the matter of the left knee condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication. In the matter of the contended Category II sciatica, the panel agrees it cannot recommend it for additional disability rating. In the matter of the contended right knee osteoarthropathy, neurodermatitis, seasonal allergic rhinitis and left ulnar neuropathy, the panel recommends no change from the PEB determinations as not unfitting. 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:

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

I!l REPLY REFER TO ,
1850
CORB: 003
10 Sep 20

From: Director, Secretary of the Navy Council of Review Boards To:

Subj: PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) Ref:	(a) DoDI 6040.44
1.	Pursuant to reference (a), the PDBR reviewed your case and forwarded its recommendation to the Department of the Navy on 13 Aug 2020 for appropriate action.

2.	On 27 August 2020, the Assistant Secretary of the Navy (Manpower & Reserve Affairs) accepted the recommendation of the PDBR ofno 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.