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-2019-00001

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, Machine Gunner, medically separated for “joint pain localized to left hip” and “lumbago,” each rated 10%, with a combined disability rating of 20%. The PEB analogously coded the left hip condition 5099-5003 (degenerative arthritis) and listed snapping hip syndrome and pes planus conditions as related Category II diagnoses contributing to the disability in this case. The panel considered this impairment and agreed the left snapping hip syndrome was properly subsumed under the overall rating for the left hip condition IAW §4.14 (avoidance of pyramiding; more than one rating based on the same impairment is prohibited). The implied right snapping hip syndrome and pes planus will be discussed separately below. The VA adjudicated the left hip condition as not service connected based on the Compensation and Pension examination, citing no permanent residual or chronic disability. There was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion, extension, or thigh impairment for greater than a 10% rating (codes 5251, 5252, or 5253). The panel next considered rating analogous to code 5255 (femur, impairment) and adjudged that the CI’s impairment at separation did not more nearly approximate the
“moderate” knee or hip disability level to warrant the next higher (20%) rating. 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 left hip condition.

The PEB coded the back condition 5237 (lumbar spine strain) and the VA rated the lumbar spine condition 0%, coded 5242 (degenerative arthritis of the spine), based on the C&P examination, citing normal range of motion of the thoracolumbar spine without evidence of pain. 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), as reported on the sports examination. Alternatively, chiropractic notes documented tenderness and/or painful motion on multiple evaluations. 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 lumbago condition.

In the matter of the contended right snapping hip syndrome and pes planus, the panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not separately unfitting and separately ratable.  Regarding the right snapping hip syndrome, the preponderance of the record specified and focused on the unfitting left hip.  The right hip was not noted on limited duty (LIMDU) forms, and not implicated in any of the MEB narrative summaries (NARSUMS) and addendums. The MEB diagnosis of “pain in joint involving pelvic region and thigh” did not specify a side and the non-medical assessment (NMA) only implicated non-specific “hip” trouble which did not specify a side. There was no performance-based evidence from the record that the right hip condition significantly interfered with satisfactory duty performance at separation. In addition, there were no ratable elements to the right hip examinations proximate to separation. After due deliberation, the panel agreed the preponderance of the evidence with regard to the functional impairment of the right hip indicated the right hip did not rise to the level of being unfitting, and agrees it cannot recommend it for additional disability rating.

Regarding pes planus, the foot condition was not noted on LIMDU forms, and not implicated in any of the MEB NARSUMS/addendums, or the NMA. Service treatment record entries indicated the condition was well controlled with custom arch supports. There was no performance-based evidence from the record that pes planus significantly interfered with satisfactory duty performance at separation. After due deliberation, the panel agreed the preponderance of the evidence with regard to the functional impairment of the pes planus did not rise to the level of being unfitting, and the panel agrees it cannot recommend it for additional disability rating.

In the matter of the Category III contended paroxysmal atrial fibrillation, hypertension, vocal cord dysfunction and deviated septum, along with other symptoms involving the head and neck, and cervicalgia, the panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting (or implied as not unfitting). None of the conditions were noted on LIMDU forms proximate to separation although the cardiac condition had been on a temporary 6-month LIMDU following cardioversion, and the CI was subsequently cleared for full duty. The NMA mentioned irregular heartbeat, however, the evidence indicates that the CI had been returned to full duty for any cardiac condition. There was no performance-based evidence from the record that any of the conditions significantly interfered with satisfactory duty performance at separation. After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination (or implied fitness determination) for any of the contended conditions, so no additional disability ratings are recommended.

2	PD-2019-00001

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

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IN RE PLY 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.