RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW NAME: XXXXXXXXXXXXXXXXXX CASE: PD1201901 BRANCH OF SERVICE: ARMY BOARD DATE: 20130320 SEPARATION DATE: 20031226 SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (63W/Wheeled Vehicle Repair) medically separated for chronic low back pain (LBP). The back condition began in 2001 and was treated with medication and acupuncture. Despite treatment, the CI did not improve adequately to fully perform his military duties or meet physical fitness standards. He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB). The MEB forwarded chronic LBP and mild degenerative disk disease (DDD) as not meeting retention standards IAW AR 40-501. No other conditions were forwarded for Physical Evaluation Board (PEB) adjudication. The PEB found the chronic LBP unfitting and rated it 10%. The CI made no appeals and was medically separated with a 10% disability rating. CI CONTENTION: “Multiple connections leading to and including sleep apnea that originated from the service connected disability of degenerative disk disease also force me to not get a good night’s sleep with a sleep aide. The sleep aide… ” [sic]. The application continues with contentions including the already quoted sleep apnea, stress/anxiety, migraines and hearing issues, concluding with “…I believe all of these things should be re-evaluated and I deserve a higher percentage overall.” SCOPE OF REVIEW: The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, and paragraph 5.e. (2). It is limited to those conditions determined by the PEB to be unfitting for continued military service and those conditions identified but not determined to be unfitting by the PEB when specifically requested by the CI. Ratings for unfitting conditions will be reviewed in all cases. The rated, unfitting condition of chronic LBP meets the criteria prescribed in DoDI 6040.44 for Board purview. The requested sleep apnea, anxiety, migraine and sleep conditions were not identified in the PEB and thus are not within the DoDI 6040.44 defined purview of the Board. Any conditions or contention not requested in this application or otherwise outside the Board’s defined scope of review remain eligible for future consideration by the Army Board for Correction of Military Records. The Board’s authority is limited to making recommendations on correcting disability determinations. The Board’s role is therefore confined to the review of medical records and all evidence at hand to assess the fairness of PEB rating determinations, compared to the Veterans’ Administration Schedule for Rating Disabilities (VASRD) standard, based on ratable severity at separation. RATING COMPARISON: Service PEB – Dated 20030912 VA – (1 Week Pre-Separation) Condition Code Rating Condition Code Rating Exam Chronic LBP 5299-5295 10% Bulging Disc L5-S1* 5242 10% 20031029 No Additional MEB/PEB Entries Other x 1 20031029 Combined: 10% Combined: 10% VARD 20031217 (most proximate to Date of Separation) * Later changed to DDD with Lumbar Strain, kept 10% rating. ANALYSIS SUMMARY: The Board acknowledges the CI's contention that disability ratings should have been conferred for other conditions. While the Disability Evaluation System considers all of the CI’s medical conditions, compensation can only be offered for those conditions that cut short a member’s career, and then only to the degree of severity present at the time of final separation. The Veterans’ Administration, however, is empowered to compensate for service-connected conditions and to periodically re-evaluate said conditions, and adjust the CI’s disability rating should the degree of impairment change over time. Low Back Pain (LBP). The CI injured his back during physical training in April 2000. Many different treatment options were tried; including medications, acupuncture, and physical therapy (PT). However, in spite of treatment, the LBP persisted and an MEB was initiated. The MEB clinical evaluation was in January 2003, 50 weeks prior to separation. The CI reported that his pain was exacerbated by certain activities like running, jumping, lifting, or marching. However, there were no limitations in activities of daily living. Physical examination showed some tenderness to palpation (TTP) in the L5-S1 region. On forward bending, his fingers came to within 6 inches of the floor. Trunk rotation was functional. In the lower extremities, active range-of-motion (ROM) was full. Neurological exam was normal, and straight leg raise (SLR) was negative. On 29 October 2003, 8 weeks prior to separation, the CI had a VA Compensation and Pension (C&P) exam. He reported that he could walk two miles before pain occurred. For exercise he was doing upper body weight training. He denied ever being on bed rest or missing work. Gait and posture were normal. Neurological exam was normal. Goniometric evaluation of the back revealed essentially full ROM of the lumbosacral spine, but no actual measurements were documented by the examiner. There was subjective TTP over the entire lumbosacral spine and both sacroiliac joints, but no paraspinal muscle spasm. Toe-walk, heel-walk, and tandem walk were all normal. Neurological exam was normal. The Board carefully reviewed all evidentiary information available, and directs attention to its rating recommendation based on the above evidence. The Army PEB and VA chose different coding options for the LBP condition, but both assigned a rating of 10%. The PEB used VASRD code 5299-5295 (analogous to lumbosacral strain). The VASRD coding and rating standards for the spine were modified in September 2002, and then were changed to the current standards in September 2003. IAW DoDI 6040.44, the Board must use the VASRD coding and rating standards which were in effect at the time of the CI’s separation. Based on the evidence in the treatment record, the Board unanimously agreed that the CI’s low back condition would best be coded as 5242 (degenerative arthritis of the spine), and rated at 10%. This coding and rating option is most appropriate to the CI’s underlying spinal pathology. The code used by the PEB was no longer a valid VASRD code at the time of separation. All clinical data in evidence are consistent with a 10% rating under the VASRD General Rating Formula for Diseases and Injuries of the Spine. There was no evidence of incapacitating episodes, nor was there sufficient evidence of ratable peripheral nerve impairment. The Board discussed other reasonable coding options, but could not find a path to a rating higher than 10%. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board unanimously recommends a disability separation rating of 10% for the LBP condition. It should be appropriately coded 5242, IAW §4.71a of the VASRD in effect at the time of the CI’s separation from service. As noted above, the code used by the Army PEB was no longer a valid VASRD code at the time of separation. BOARD FINDINGS: IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB will not be considered by the Board to the extent they were inconsistent with the VASRD in effect at the time of the adjudication. In the matter of the chronic LBP, the Board unanimously recommends a separation disability rating of 10%, coded 5242 IAW §4.71a of the VASRD in effect at the time of separation. There were no other conditions within the Board’s scope of review for consideration. RECOMMENDATION: The Board, therefore, recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation: UNFITTING CONDITION VASRD CODE RATING Chronic Low Back Pain 5242 10% COMBINED 10% The following documentary evidence was considered: Exhibit A. DD Form 294, dated 20121031, w/atchs Exhibit B. Service Treatment Record Exhibit C. Department of Veterans’ Affairs Treatment Record xxxxxxxxxxxxxxxxxxxxxxxxx, DAF Acting Director Physical Disability Board of Review SFMR-RB MEMORANDUM FOR Commander, US Army Physical Disability Agency (TAPD-ZB / xxxxxxxxxxxxxxx), 2900 Crystal Drive, Suite 300, Arlington, VA 22202- 3557 SUBJECT: Department of Defense Physical Disability Board of Review Recommendation for xxxxxxxxxxxxxxxxxxxxxxxxxxxx, AR20130007797 (PD201201901) 1. I have reviewed the enclosed Department of Defense Physical Disability Board of Review (DoD PDBR) recommendation and record of proceedings pertaining to the subject individual. Under the authority of Title 10, United States Code, section 1554a, I accept the Board’s recommendation to modify the individual’s disability description without modification of the combined rating or recharacterization of the individual’s separation. This decision is final. 2. I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum. 3. I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures. BY ORDER OF THE SECRETARY OF THE ARMY: Encl xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx Deputy Assistant Secretary (Army Review Boards)