RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXXXXX	CASE: PD-2017-04818
BRANCH OF SERVICE: MARINE CORPS	SEPARATION DATE: 20040831

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Engineer Equipment Mechanic, medically separated for “chronic low back pain” with a disability rating of 20%.

CI  CONTENTION:   Back  condition continues  to worsen and negatively  impact daily life.	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 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 - 20040604	VARD - 20041014	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5237	20%	Degenerative Disc Disease of the Lumbosacral Spine with Herniation and Stenosis	
5242	
10%	
20040625	
Herniation of Intra Vertebral Discs at L3/L4, L4/L5 and L5/S1	Cat II					
Lumbar Stenosis L3/L4 to L5/S1	Cat II					
COMBINED RATING: 20%	COMBINED RATING OF ALL VA CONDITIONS: 10%	

ANALYSIS SUMMARY:

Chronic Low Back Pain. According to the service treatment record and MEB narrative summary (NARSUM), the CI’s low back pain began in 1996 and continued throughout his career. There was no surgical indication and X-rays from December 2003 showed lower lumbar stenosis. During the 16 December 2003 neurosurgery evaluation, 9 months prior to separation, the provider noted tenderness with no muscle spasm, and lumbar flexion to 60 degrees (normal 90), extension to 10 degrees (normal 30), and lateral flexion to 20 degrees bilaterally (normal 30). The 14 April 2004 MEB examination (recorded on DD Forms 2807-1 and 2808) and the 15 April 2004 MEB NARSUM examination, 4 months prior to separation, both recorded lower back tenderness. The examiner noted that flexion and extension were significantly limited (not quantified) due to pain, with bilateral rotation to approximately 30 degrees (normal), and right and left lateral flexion to about 20-30 degrees (normal 30), also limited secondary to pain.

At the 24 June 2004 VA Compensation and Pension (C&P) examination, 2 months before separation, the CI reported radiation of pain into the legs, particularly on the right side with strenuous exertion, and 3 days of bedrest during the past year because of low back pain. The examiner found tenderness, but no evidence of muscle spasm. Measured ROM showed thoracolumbar flexion to 70 degrees with a combined ROM of 170 degrees.

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), and listed herniation of intra vertebral discs at L3/L4, L4/L5 and L5/S1, and lumbar stenosis L3/L4 through L5/S1, as Category II conditions (contributed to the primary unfitting condition but not separately ratable). Panel members agreed that the impairment from these related diagnosis were properly subsumed under the overall rating for the chronic low back pain IAW §4.14 (avoidance of pyramiding; more than one rating based on the same impairment is prohibited). The VA rated the low back condition 10%, coded 5242 (degenerative arthritis of the spine), based on the C&P examination. The panel noted that the neurosurgeon measured lumbar ROM rather than thoracolumbar ROM as specified by the VASRD (§4.71a, Plate V), and the NARSUM examiner did not provide full ROM measurements to properly determine a rating IAW VASRD criteria. Thus, panel members agreed that the VASRD compliant C&P examination provided the most probative ROM measurements and warranted a 10% rating for thoracolumbar flexion greater than 60 degrees but not greater than 85 degrees. 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.

2	PD-2017-04818

DEPARTMENT OF THE NAVY
SECRETARY OF TI-IB 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:	XXXXXXXXXXXXX

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.