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-2018-00303

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 a Reserve E3, Motor Vehicle Operator, medically separated for “L5-S1 central disc herniation, with mild spinal stenosis and narrowing of neural foramina bilaterally” with a disability rating of 10% which the PEB coded 5238 (spinal stenosis). The VA also rated the back condition 10%, coded 5237 (lumbar spine strain), based on the Compensation and Pension examination, citing forward flexion of the thoracolumbar spine limited to 80 degrees. The panel noted that the preponderance of range of motion (ROM) in evidence (within 2 years prior to separation to 6 months after separation) supported a 10% rating. The MEB narrative summary examination 7 months prior to separation noted flexion of 20 degrees, as did an earlier 2006 examination by the same examiner, however, such severe limitation of motion was not noted by any other examiner. The panel reviewed the orthopedic finding of 20 degrees flexion and noted the examiner referred to it as lumbar ROM raising the possibility that this reflected isolated lumbar ROM (normal 60 degrees) and not thoracolumbar ROM (normal 90) as required by the VASRD. If so, it reflected thoracolumbar ROM of 50 degrees of flexion, still lower than at other examinations, but not nearly as discrepant.  It was also not clear to the panel if the ROM values of the March 2006 examination (noted to be the basis for an initial PEB dictation) were carried over from the earlier examination rather than repeated. The VA examination was the most proximate to separation and the ROM was most clearly documented as thoracolumbar ROM and in degrees, and was supported by multiple other ROM examinations in the record.  For these reasons the panel provided greater probative value to the VA examination. 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 documented at the VA examination and supported by the total evidence in record. 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 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.

The PEB listed broad-based diffuse disc bulge, L4-l5, with facet hypertrophy and neural foramina narrowing bilaterally as a related Category III condition that was not separately unfitting and did not contribute to the unfitting condition. The impairment from the contended condition must be subsumed under the overall rating for the Category I unfitting back condition IAW §4.14 (avoidance of pyramiding; more than one rating based on the same impairment is prohibited). After due deliberation, the panel concluded they could not recommend an additional disability rating.

2	PD-2018-00303

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

Ill REPLY REF ER 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 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.