RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:	CASE:  PD-2017-0547	3
BRANCH OF SERVICE: MARINE CORPS	SEPARATION DATE: 20060415
SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Rifleman, medically separated for “disc bulge L3-4, L4-5, S1” with a disability rating of 20%.
CI CONTENTION: Review of all conditions requested. 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 - 20060214	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Disc Bulge L3-4, L4-5, S1	5237	20%	No VA Examination Proximate to Separation in Evidence	
L5 Radiculopathy	Cat II		
COMBINED RATING: 20%	COMBINED RATING OF ALL VA CONDITIONS: NA	

ANALYSIS SUMMARY:

Disc Bulge L3-4, L4-5, S1. According to the service treatment record and MEB narrative summary (NARSUM), the CI’s disc bulge condition began in November 2004 after falling 50 feet during a fast-roping exercise, followed by performing a fireman's carry of another Marine. Imaging (lumbar spine CT in 2004 and MRI in August 2005) showed degenerative changes with the worst level being L3-4 (moderate spinal narrowing.) A lumbar spine CT scan completed in March 2005 showed a central disk protrusion at L4 which caused moderate canal stenosis. The L5 right foramen appeared patent, but on the left an adjacent bulging disk was present, contacting the left L5 nerve root. The CI was not considered a good surgical candidate at the time.

During the 19 October 2005 MEB examination (recorded on DD Forms 2807-1 and 2808), 6 months prior to separation, the CI reported chronic low back pain (LBP) due to the injury he sustained while fast roping. Physical examination revealed tenderness over the lower lumbar spine. An undated MEB NARSUM examination referred to the 16 November 2005 MEB NARSUM physiatry addendum examination, 5 months prior to separation. The addendum noted complaints of LBP. Range of motion (ROM) measurements in degrees showed flexion to 65

(normal 90) after three repetitions, extension to 10 (normal 30), left rotation to 30 (normal), right lateral flexion to 40 and left lateral flexion to 45 (normal 30 for both). There was no right rotation measured, however combined thoracolumbar ROM was 165 degrees or greater.

At a 31 January 2007 VA pain clinic examination, 10 months after separation, the CI reported LBP. Physical examination noted an antalgic gait. Back ROM was flexion of 90 degrees and combined ROM of 230 degrees (normal 240). All movements were with pain and tenderness was present. There was no VA Compensation and Pension examination proximate to separation in evidence.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the disc bulge condition 20%, coded 5237 (lumbar spine strain) without citing a basis. The panel agreed that a 10% rating, but no higher, was justified for limitation of flexion (greater than 60 degrees but not greater than 85 degrees) and combined ROM (greater than 120 degrees but not greater than 235 degrees), as reported on the MEB physiatry addendum and VA pain clinic examinations. 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 intervertebral disc syndrome which resulted in incapacitating episodes requiring physician-prescribed bed rest to warrant consideration of rating under the alternate VASRD formula for that condition.

The PEB listed L5 radiculopathy as a Category II condition that is related and contributes to the primary unfitting condition. The CI was diagnosed with bilateral L5 radiculopathy and the PEB did not specify in its adjudication whether the radiculopathy was  right, left, or bilateral.  The  24 May 2005 LIMDU listed “multiple HNP” and the 10 August 2005 listed multiple herniated discs with chronic LBP. The NMA did not specifically identify the CI’s medical conditions. The MEB forwarded “unspecified neuralgia, neuritis, and radiculitis” to the PEB. The panel agreed there was not preponderance of evidence to overcome the panel’s presumption that the L5 radiculopathy was separately unfitting apart from the Category 1 disc bulge condition.

The panel next considered if each of the right and left radiculopathy conditions was reasonably considered unfitting at separation. At a neurosurgery consult on 8 August 2005, 9 months before separation, the CI reported pain radiating greater down the right lower extremity (LE) than the left. The CI was treated with three selective nerve root blocks for right LE pain and numbness which provided “moderate to excellent relief,” although the pain returned at times. He was not treated for left LE symptoms. The 16 November 2005 MEB NARSUM physiatry addendum physical examination showed normal strength and reflexes of both LEs with normal sensation of the left LE and “mild decrease in sensation in the right L5 dermatome.” The panel concluded there was not a preponderance of evidence to overcome the presumption that the Category II right L5 radiculopathy was unfitting, however, the panel agreed that the evidence in the STR provides a preponderance of evidence that the left L5 radiculopathy was much less severe than the right and would not by itself have caused the CI to be referred into the DES system.

At an outpatient VA pain consult on 31 January 2007, 10 months after separation, the CI reported intermittent right LE pain, approximately one day per week. He reported improvement with the right L5 selective nerve root blocks, but they only lasted a couple months. Physical examination showed normal LE strength. A straight leg raise test was positive on the right and there was decreased sensation in the right L4-5 and L5-S1 dermatomes.

The panel directed attention to its rating recommendation based on the above evidence. Proximate to separation, the CI reported right LE pain and numbness and there was objective decreased sensation in the L4 and L5 dermatomes noted on examinations. The panel agreed a 10% rating and no higher was supported coded as 8620 for mild neuritis of the sciatic nerve. The panel found that its recommendation of a 10% rating for the disc bulge condition and recommendation of an unfitting right L5 radiculopathy condition rated 10% results in no ratings

benefit to the CI. 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 disc bulge condition.

BOARD FINDINGS: In the matter of the disc bulge L3-4, L4-5, S1 condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication. In the matter of the L5 radiculopathy condition, the panel recommends no change from the PEB determination as a Category II condition. 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

IN REPLY REFER TO :
1850
CORB: 003
10 Sep20

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 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.