DEPARTMENT OF THE AIR FORCE
WASHINGTON DC

Office of the Assistant Secretary

SAF/MRBD (PDBR)
3351 Celmers Lane
JBA NAF Washington, MD 20762-6435

MEMORANDUM FOR THE ASSISTANT SECRETARY OF THE NAVY, MANPOWER AND RESERVE AFFAIRS

SUBJECT: Physical Disability Board of Review Recommendation on Case Number PD-2018-00273

In accordance with Title 10 § 1554a and in compliance with DoDI 6040.44, the Physical Disability Board of Review (PDBR) adjudicated the disability rating accompanying the medical separation of the covered individual from the United States Marine Corps. After carefully reviewing the application and medical separation case file, the PDBR recommended no re- characterization of the separation or modification of the disability rating previously assigned. I recommend you accept this proposed decision.

The covered individual (CI) was an active duty E4, Rifleman, medically separated for “herniated nucleus pulposus at L4, L5” with a disability rating of 10%. The PEB analogously coded the condition 5299-5293 however, code 5293 does not exist in the VASRD and it was suspected that this was a typographical error for the intended code 5243 (intervertebral disc syndrome). The panel agreed that the Category II conditions that contribute to the unfitting condition (disk degeneration L4, L5 and mechanical low back pain) were intrinsic to the rated condition such that separate ratings could not be supported without violation of VASRD §4.14 (avoidance of pyramiding), and were thus appropriately subsumed in the same rating. The VA rated the condition 20% coded 5242 (degenerative arthritis of the spine), based on the pre- separation VA Compensation and Pension (C&P) examination. A specific rationale for the 20% rating was not provided, and the measured range of motion (ROM) by the C&P examiner supported only a 10% rating. The panel noted that flexion to 40 degrees, as noted in the narrative summary (NARSUM), meets the VASRD §4.71a spine rating 20% criterion for limitation of flexion greater than 30 degrees but not greater than 60 degrees. Panel members therefore deliberated whether that finding was sufficiently probative to support the higher rating. Members ultimately agreed that it was not. The C&P ROM evidence was more temporally probative to separation and was of a higher quality. It quantified painful motion and the response to repetition (DeLuca considerations), and the NARSUM annotation of approximate flexion was dubiously compliant with VASRD §4.46 (accurate measurement). All of the STR provider evidence was inconsistent with the NARSUM ROM, and the former reflected multiple observations over an extended period for a stable condition. The panel thus 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/or combined ROM (greater than 120 degrees but not greater than 235 degrees), as reported in the pre-separation C&P examination. There was no evidence for abnormal gait or spinal contour in support of a 20% rating, and no evidence for 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 lumbar spine condition.

2	PD-2018-00273

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

HI REPLY REFER TO:
1850
CORB: 003
10 Sep20

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

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.