RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXXXXXXXX	CASE: PD-2017-02984
BRANCH OF SERVICE: MARINE CORPS	SEPARATION DATE: 20081030

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Mortarman, medically separated for “vertebral body compression fracture” with a disability rating of 20%.

CI CONTENTION: “Had to pay for back surgery, no help from VA, unable to hold steady job due to back injury.”  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 - 20080821	VARD – 20090123	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Compression Fracture, L4 Vertebral Body	5235	20%	Lumbar Spine Degenerative Joint Disease	5242	10%	20081118	
Lumbago	Cat II					
COMBINED RATING: 20%	COMBINED RATING OF ALL VA CONDITIONS: 30%	

ANALYSIS SUMMARY:

L4 Compression Fracture. According to the service treatment record and MEB narrative summary (NARSUM), the CI’s back condition began in December 2006 after a helicopter crash while deployed. The 1 November 2007 MEB NARSUM examination, 12 months prior to separation, noted complaints of back pain. Physical examination showed a normal gait and the CI was able to heel and toe walk without any problems. There was mild tenderness and some degree of hamstring weakness with loss of flexion. Lower extremity muscle strength and reflexes were normal.       Thoracolumbar range of motion (ROM) testing showed flexion of “approximately 60

degrees” (normal 90) and combined ROM of approximately 210 degrees (normal 240). Painful motion was noted.

At the time of the orthopedic clinic appointment on 28 February 2008, 8 months prior to separation, the CI reported low back pain. On examination the CI had a normal posture and there was no limp, antalgic gait, tenderness or spasm. Straight leg raise testing was negative bilaterally and lower extremity strength was normal. Thoracolumbar ROM testing showed flexion of 90 degrees with fingers touching the floor, extension of 5 degrees (normal 30) and lateral bending of 15 degrees (normal 30) bilaterally. An MRI in March 2008 showed an old partial compression fracture at L4. The height of the L4 vertebral body was uniformly decreased by approximately 10% and there was no significant retropulsion of fracture material into the central neural canal or the neural foramina. There was very minimal bulging at L4-5 and L3-4, and no associated narrowing of the central neural canal or significant narrowing of the bilateral neural foramina.

At the 18 November 2008 VA Compensation and Pension (C&P) examination, 1 month after separation, the CI reported pain (8/10) in the lower mid back which occurred constantly. The pain was elicited by physical activity but there was no incapacitation. Physical examination showed normal posture and gait without evidence of radiating pain on movement, and no evidence of spasm or ankylosis, but tenderness was present. Straight leg raise testing was negative. The neurologic examination including strength, coordination, sensation and reflexes was normal. Thoracolumbar ROM testing showed flexion of 90 degrees and combined ROM of 230 degrees. Painful motion was noted. X-rays revealed mild kyphotic curvature of the lumbar spine at L3-4. There was a fracture at L4 with loss of approximately 50% of vertebral body height anteriorly.  Mild retrolisthesis of L4 in relation to L5 and L3 was noted.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the back condition 20%, coded 5235 (vertebral fracture). The PEB also listed lumbago as a related Category II condition (contributed to the primary unfitting condition but was not separately ratable). The lumbago was part and parcel of the unfitting back condition and could not be separately rated without pyramiding IAW §4.14. The VA rated the back condition 10%, coded 5242 (degenerative arthritis of the spine), based on the C&P examination, citing localized tenderness not resulting in abnormal gait or abnormal spinal contour. The panel agreed that a 20% rating, but no higher, was justified for limitation of flexion (greater than 30 degrees but not greater than 60 degrees), as reported on the MEB NARSUM examination. 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 back condition.

BOARD FINDINGS: In the matter of the 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 20170314, w/atchs Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

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 2 Apr 19

I. 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 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.