RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXXXXX		CASE: PD-2017-04506 BRANCH OF SERVICE: MARINE CORPS	SEPARATION DATE: 20060701

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Field Artillery Cannoneer, medically separated for “multilevel lumbar spondyloarthropathy” with a disability rating of 20%.

CI CONTENTION: “The unfit condition could be progressive in nature and has not been monitored and adjusted.” 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 – 20060508	VARD - 20070615	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Multilevel Lumbar Spondyloarthropathy	5237	20%	Lumbar Facet Degenerative Joint Disease and Degenerative Disc Disease L3-4, L4-5 and L5-S1 Levels	5242	10%	20070103	
COMBINED RATING: 20%	COMBINED RATING OF ALL VA CONDITIONS: 40%	

ANALYSIS SUMMARY:

Multilevel Lumbar Spondyloarthropathy. According to the service treatment record and MEB narrative summary (NARSUM), the CI’s back condition began in March 2005 with complaints of low back pain radiating to the left leg. He denied any specific injury or trauma other than intermittent pain with prolonged exercise. On 22 April 2005, MRI studies revealed multilevel mild lumbar spondyloarthropathy with developmentally narrowed central bony canal. The CI was referred to neurosurgery but was determined to not be a surgical candidate. He underwent a nerve block and denervation and had an epidural steroid injection, but the pain continued.

The 1 December 2005 MEB NARSUM examination, 7 months prior to separation, noted the history as documented above, but no physical examination findings were provided. During the  6 March 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 4 months before separation, the CI reported back pain and radiating pain, and use of narcotic medication and muscle relaxants. Physical examination was not descriptive for the spine (check-marked normal).

At the 3 January 2007 VA Compensation and Pension (C&P) examination, 6 months after separation, the CI reported low back pain with right buttock pain and decreased endurance, but improvement in the left leg pain. Physical examination showed lumbar tenderness, but a normal gait and spinal contour, with no spasms. There were no incapacitating episodes in the previous 12 months due to the back condition. Range of motion (ROM) showed forward flexion to 90 degrees (normal) and combined ROM of 230 degrees (normal 240). With repetition, the CI had a pain flare at 90 degrees of flexion and 20 degrees of extension.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the lumbar spine condition 20%, coded 5237 (lumbar spine strain). The VA rated the lumbar spine condition 10%, coded 5242 (degenerative arthritis of the spine), based on the C&P examination, citing forward flexion of 90 degrees and combined ROM of 230 degrees. Panel members found no evidence to support limitation of motion less than 30 degrees flexion or ankylosis for a higher 40% rating. There was no evidence of intervertebral disc syndrome which resulted in incapacitating episodes requiring physician-prescribed bed rest to warrant consideration under that formula. Thus, there was no evidence to support a rating higher than that adjudicated by the PEB. 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 lumbar spine condition.

BOARD FINDINGS: In the matter of the lumbar spine 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:

2	PD-2017-04506

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
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.