RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXX	CASE:  PD-2013-02570
BRANCH OF SERVICE:  Army	BOARD DATE:  20140828
SEPARATION DATE:  20040913

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (63S/Heavy Wheel Vehicle Mechanic) medically separated for chronic low back pain (LBP).  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty.  He was permitted to take the alternate Army physical fitness test (aerobic portion).  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The MEB forwarded “chronic LBP” to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other conditions were submitted by the MEB.  The PEB adjudicated “chronic LBP, without neurologic abnormality” as unfitting, rated at 10%, with probable application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  “I was quickly med boarded with no options given.  Since then, my percentage has increased by 10% w/ and inclusion of my knee.  (cont. from block 12): and I also have other claims pending.”

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, 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.  The rating for the unfitting chronic low back condition is addressed below.  The contended knee condition was not mentioned by the MEB or PEB and is therefore not within the Board’s purview.  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 Board for Correction of Military Records (BCMR).  IAW DoDI 6040.44, the Board’s authority is limited to making recommendations on correcting disability determinations.  

RATING COMPARISON:

Service IPEB – Dated 20040712 | VA - (3 Mos. Pre-Separation)
Condition | Code | Rating | Condition | Code | Rating | Exam
Chronic LBP without Neurologic Abnormality | 5299-5237 | 10% | Chronic LBP with Fractured Vertebral Bodies… | 5237-5235 | 10% | 20040624
Other x 0 (Not in Scope) | Other x 0 | 20040624
Combined:  10% | Combined:  10%
Derived from VA Rating Decision (VARD) dated 20040929 (most proximate to date of separation)
VARD 20111220 increased DC 5237-5235 to 20% effective 20101012

ANALYSIS SUMMARY:

Chronic Low Back Condition.  The first recorded visit for back pain in evidence was dated 6 November 2002 when the CI presented with a 2-day history of pain after lifting up a heavy ruck sack.  The next record is a lumbar X-ray on 13 June 2003 which was normal.  It noted a 9-month history of atraumatic LBP.  At a physical therapy (PT) evaluation on 14 October 2003, he reported a 2-year history of LBP since he had fallen off of a vehicle.  On examination, he was noted to have 63 degrees of flexion and that 3/5 signs of non-organic pain were present.  He continued PT with minimal improvement.  At the 9 November 2003 evaluation, his forward flexion was 60 degrees.  His active flexion was reduced to 15 degrees; however, passive flexion was 65 degrees.  On 6 January 2004, he reported being in a car accident 5 days earlier (he hit a deer) and his flexion was reduced to 10 degrees.  An X-ray that day showed a mild wedge deformity (possibly indicative of an old compression fracture) of the lower thoracic spine which was unchanged from the previous examination (which was read out as normal).  A magnetic resonance imaging (MRI) on 2 March 2004 was read as showing minimal wedging of T12 which was either an old compression fracture or a normal variant.  No disc pathology was noted.  A subsequent CT scan on 30 March 2004 was read as a “normal dedicated CT.”  The CI was then referred to neurosurgery and entered into the MEB process.  

At the MEB examination on 16 April 2004 (5 months prior to separation), the CI reported on going back pain.  The MEB physical examiner noted tenderness to palpation (TTP) over the lumbar spine and sacro-iliac joints.  The range-of-motion (ROM) was limited and charted below.  The CI was issued an L3 profile on 29 April 2004.  He was evaluated in neurosurgery on 10 May 2004.  The neurosurgeon noted that the MRI and CT were normal.  The gait was antalgic (guarding against pain.)  The neurological examination was normal.  Provocative testing of nerve root irritation was positive.  The active forward flexion was “moderately limited with the production of low back pain.”  Surgery was not thought to be of benefit.  The narrative summary was dated 20 May 2004, 4 months prior to separation.  The CI reported history of LBP since he had fallen in Korea around October/November 2001 that became worse over a period of 9 to 11 months.  He was limited to sedentary work and could not meet field duty requirements.  TTP along the lumbosacral spine and spasm were noted.  The reflexes were normal and atrophy absent.  Heel and toe movement, strength, and standing were normal.  The ROM is below.  

At the VA Compensation and Pension (C&P) examination performed less than 3 months prior to separation; the CI reported that his pain did not cause incapacitation.  He reported no functional impairment and stated that there was no time lost from work.  He was able to perform the activities of daily living including mowing the lawn.  Gait and posture were normal.  The ROM was full and pain free (see below chart).  Repetition resulted in no additional limitation in motion.  Spasm was absent as were signs of intervertebral disc syndrome.  The neurological examination was normal.  Compression fractures at T11 and T12 were noted on X-ray with a loss of height of 26% and 18%, respectively.  The goniometric ROM evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.

Thoracolumbar ROM
(Degrees)

PT ~10 Mo. Pre-Sep

MEB ~5 Mo. Pre-Sep

VA C&P ~3 Mo. Pre-Sep

Flexion (90 Normal) | 60 | 25 | 90
Combined (240) | --- | 75 | 240
Comment | See above discussion | Painful motion | Motion pain free; DeLuca negative
§4.71a Rating | 20% | 40% | 0%

The Board directed attention to its rating recommendation based on the above evidence.  The PEB and VA both rated the back at 10%, but coded it as 5299-5237 (analogous to lumbosacral strain), and 5237-5235 (lumbosacral strain and vertebral fracture).  The Board considered the findings.  Multiple X-rays indicated a possible compression fracture, but others were normal including a CT scan, a more definitive test.  The ROM testing showed a significant variation as well.  The MRI showed no degenerative disc disease and no degenerative joint disease.  The neurological examination was consistently normal.  The Board considered the different examinations and determined that the VA C&P examination had the highest probative value.  It was closest to separation, the most complete examination for rating purposes and best fit the demonstrated pathology.  Although the VA adjudicated a 10% rating (it is not clear what the basis of this was from the rating discussion), the examination actually warrants a 0% rating.  However, the Board does not recommend a rating lower than that assigned by the PEB.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the back condition.

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.  The Board did not surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD were exercised.  In the matter of the back condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION:  The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20131201, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

			
XXXXXXXXXXXXXX
President
Physical Disability Board of Review

SAMR-RB									

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXX, AR20150007071 (PD201302570)

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 and hereby deny the individual’s application.  
This decision is final.  The individual concerned, counsel (if any), and any Members of Congress who have shown interest in this application have been notified of this decision by mail.

BY ORDER OF THE SECRETARY OF THE ARMY:

Encl						     XXXXXXXXXXXXXX
						     Deputy Assistant Secretary of the Army
						          (Review Boards)
						         
CF: 
(  ) DoD PDBR
(  ) DVA

PD-2013-02570