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-2018-00370

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 E3, Basic Marine, medically separated for “chronic radiating low back pain” and “right hip pain” rated 10% each, with a combined disability rating of 20% which the PEB coded 5237 (lumbar spine strain). The VA rated the low back condition 0%, coded 5242 (degenerative arthritis of the spine), based on the Compensation and Pension (C&P) examination, citing full range of motion (ROM) of the lumbar spine without pain during active and repetitive motion testing. There was no limitation of thoracolumbar spine motion to support a 10% rating under the General Rating Formula for Diseases and Injuries of the Spine, however the MEB narrative summary examination noted the presence of painful motion. A 10% rating was therefore warranted. At the VA examination, 2 days after separation, examination showed normal gait and the thoracolumbar spine showed normal ROM, without muscle spasm. The CI denied periods of incapacitation. There was no evidence of intervertebral disc syndrome which resulted in incapacitating episodes requiring physician-prescribed bed rest to warrant consideration of rating under that alternate VASRD formula. The panel concluded there was no evidence to support a rating higher than 10% as 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 low back condition.

In the matter of the right hip pain, the PEB analogously coded 5003 (degenerative arthritis). The VA also rated the right hip condition 10%, coded 5252 (limitation of flexion of thigh), based on the C&P examination, citing pain during ROM testing in flexion and rotation of the right hip. There was evidence of painful motion with functional loss supporting a 10% rating (based on §§4.59, 4.40 and 4.45). The panel considered alternative VASRD hip and analogous codes, but all were less applicable and/or not advantageous for rating.After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel

concluded that there was insufficient cause to recommend a change in the PEB adjudication for the right hip condition.

The PEB listed right knee pain due to radiation from the lower back as a Category II condition that was related and contributed to the primary unfitting condition. The panel’s first charge is to assess whether the Category II condition can be reasonably justified as separately unfitting for rating consideration. The right knee complaints were not implicated in the non- medical assessment and did not fail retention standards. Knee examination at the MEB NARSUM and VA examinations was normal and there was no weakness or sensory loss of the right lower extremity noted at either examination (summarized above). Although a Category II condition is reasonably considered separately unfitting, the panel agreed there was a preponderance of evidence that the right knee pain was not a separate condition which could be reasonably justified as separately unfitting. Radiating pain from the low back is subsumed in the panel’s rating recommendation for the low back condition above IAW VASRD 4.71a spine rating rules, and separate ratings would not be achievable without violation of VASRD §4.14 (avoidance of pyramiding).

2

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

Ill REPLY REFE R 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.