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AF | PDBR | CY2012 | PD 2012 00066
Original file (PD 2012 00066.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX         CASE: PD-2012-00066
BRANCH OF SERVICE: Army         BOARD DATE: 20140729
SEPARATION DATE: 20080710


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SSG/E-6 (19K30/Armor Crewman) medically separated for degenerative arthritis of the spine. The spine condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS). He was issued a permanent P2/L3 profile and referred for a Medical Evaluation Board (MEB). The chronic low back pain with degenerative disc disease was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. The MEB also identified and forwarded six other conditions (bilateral knee pain, sleep apnea, hypertension, dyslipidemia, delayed PTSD and adjustment disorder) all meeting retention standards for PEB adjudication. The Informal PEB adjudicated “degenerative arthritis of the spine” as unfitting, rated at 20%. The remaining conditions were determined to be not unfitting. The CI made no appeals and was medically separated.


CI CONTENTION: “The US Army rated me for 20% for my back; currently with the Veteran’s Admin I am rated at 90% overall.”


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 spine condition is addressed below. The requested bilateral knees, PTSD, obstructive sleep apnea, hypertension and hyperlipidemia conditions, which were determined to be not unfitting by the PEB, are likewise addressed below. 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.


 RATING COMPARISON :

Service IPEB – Dated 20080314
 VA - (1 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Degenerative Arthritis of the Spine 5242 20% Lumbar Spine Non Compressive Degenerative Disc 5242 20% 20080730
Bilateral Knee Pain Not Unfitting Left Knee DJD 5299-5261 10% 20080730
Right Knee DJD 5299-5261 10% 20080730
Sleep Apnea Obstructive Sleep Apnea 6847 50% 20080730
Delayed PTSD PTSD 9411 30% 20080825
Hyperlipidemia No Corresponding VA Conditions
Hypertension
Adjustment Disorder
No Other MEB/PEB Conditions
 Other x 6 20080730
Rating: 20%
 Combined: 80%
Derived from VA Rating Decision (VA RD ) dated 200 81009 ( most proximate to date of separation ).


ANALYSIS SUMMARY: The Board acknowledges the impairment with which the CI’s service-connected condition continues to burden him but notes the Disability Evaluation System has neither the role nor the authority to compensate members for anticipated future severity or potential complications of conditions resulting in medical separation. That role and authority is granted by Congress to the Department of Veterans Affairs (DVA), operating under a different set of laws. The Board considers DVA evidence proximate to separation in arriving at its recommendations. DoDI 6040.44 prescribes a 12-month interval for special consideration to post-separation evidence, which is probative to the Board’s recommendations only to the extent that it reasonably reflects the disability at the time of separation.

Degenerative Arthritis of the Spine. According to service treatment records and the orthopedic MEB narrative summary (NARSUM), the CI developed chronic low back pain associated with degenerative arthritis/disc disease of the spine during the course of his active duty career as an armor crewman. There was no specific injury to his back. According to the orthopedic NARSUM, a magnetic resonance imaging (MRI) scan demonstrated degenerative disc disease at the L5-S1 level. No herniated nucleus pulposus was found on the imaging studies. Despite treatment (including chiropractic), the CI reported persistent pain that’s preventing him from fully fulfilling his military duties thus, he requested a MEB in December 2007. The orthopedic MEB NARSUM dated 10 December 2007 noted the back pain was aggravated by activity and prevented wearing individual body armor or carrying a rucksack. There were no reports of radiation of pain, weakness, numbness, or difficulty walking. On examination, the orthopedic surgeon noted occasional lumbar spasm during the exam. Gait was normal and lumbar lordosis (contour) was normal. Range-of-motion (ROM) was measured using the dual inclinometer method (measures isolated spine segments) rather than the thoracolumbar ROM by goniometer as used for rating under the VASRD. The examiner combined the isolated lumbar flexion with the isolated thoracic flexion to report a thoracolumbar flexion of 50 degrees. Similarly, he reported thoracolumbar extension of 28 degrees (combined isolated lumbar plus isolated thoracic extension). Lateral bending was 19 degrees to the right and 15 degrees to the left. Rotation was 41 degrees bilaterally. Reported ROM was limited by pain. Straight leg raises was 61 degrees and not accompanied by report of radicular signs or symptoms.

The VA Compensation and Pension (C&P) examination on 30 July 2008 (3 weeks after separation), recorded a similar history of chronic low back pain associated with degenerative disc disease without specific injury. The CI reported occasional radiation of pain into the left thigh and intermittent foot numbness and tingling. There were no incapacitating episodes. On examination there was lumbar tenderness but no spasm. Gait was normal. The examination report indicated that the ROM was performed for the lumbar spine. Lumbar flexion was 45 degrees with pain beginning at 45 degrees. Lumber extension was 20 degrees with pain beginning at 20 degrees. Lateral bending was 25 degrees bilaterally without pain. Rotation was 25 degrees bilaterally without pain. There was no additional limitation by pain fatigability, weakness or lack of endurance following repetitive use. Strength and reflexes were normal, and straight leg raises was negative for radicular signs. The Board directs attention to its rating recommendation based on the above evidence. Both the PEB and the VA adjudicated a rating of 20% using code 5242 (degenerative arthritis of the spine) citing limitation of motion. The limitation of motion recorded in both examinations does not support a rating higher than the 20% adjudicated by both the PEB and VA based on the VASRD General Rating Formula for Diseases and Injuries of the Spine. There were no incapacitating episodes from intervertebral disc syndrome to support consideration under the alternate formula for intervertebral disc syndrome and there was no peripheral nerve impairment to support consideration of a rating for peripheral neuropathy. 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 degenerative arthritis of the spine condition.

Contended PEB Conditions. The Board’s main charge is to assess the fairness of the PEB’s determination that the conditions bilateral knee pain, delayed PTSD, adjustment disorder, sleep apnea, hypertension, and dyslipidemia were not unfitting. The Board’s threshold for countering fitness determinations requires a preponderance of evidence.

Contended Bilateral Knee Pain. In regards to the bilateral knee pain, service treatment records reflect bilateral knee pain since 2002 without injury diagnosed as patellofemoral pain syndrome. The CI presented for care in January 2006 for knee pain of 2 years duration. Orthopedic examination on 7 February 2006, recorded chronic anterior knee pain diagnosed as patellofemoral pain syndrome. The orthopedic surgeon issued a permanent L2 profile on 7 February 2006 and the CI was able to walk as an alternate event for the physical fitness test. Between October 2006 and August 2007, the CI’s walking time for the PT test improved by 1 minute. The MRI of the CI’s knees that was taken in September 2007 was determined to be normal to include ligaments, menisci and articular cartilage (without evidence of degenerative joint disease). At the time of the orthopedic MEB NARSUM examination performed on 10 December 2007, the CI reported knee pain with activity and that he was able to perform the walk portion of the PT test. The examiner noted a prior examination in July 2007, which reported a normal gait, full smooth ROM and no swelling, tenderness or instability. On current examination the examiner indicated there was no swelling, pain, or tenderness at the joint line and gait was described as normal. The examiner further noted that both knees extended fully to 0 degrees. Right knee flexion was 115 degrees and left knee flexion was 128 degrees. There was mild crepitus (grinding sensation) of the left kneecap however the kneecap apprehension sign (for patellofemoral syndrome) was negative. Both knees were ligamental stable. For the MEB examination, the orthopedic surgeon listed the bilateral knee pain as an orthopedic diagnosis. The commander’s statement dated 19 December 2007 said the CI’s two medical conditions preventing him from “…inability in performing his duties as a soldier and 19K armor crewman (were) due to his chronic LBP with degenerative disc disease and bilateral knee pain.” The MEB orthopedic surgeon further listed this diagnosis as a medical condition on the final profile and authorized wear of a knee brace. Nevertheless, the MEB document signed by the examining orthopedic surgeon and the chief of orthopedics concluded the bilateral knee pain met retention standards. The Board considered the commander’s statement and noted the L2 profile. However, the objective findings of the normal MRI and normal physical examination indicated no significant underlying pathology to support more than a mild severity of the patellofemoral pain syndrome. Despite the commander’s statement, the Board was not convinced the objective medical evidence indicated any underlying condition severe enough to cause any significant impairment. The Board concluded that a preponderance of the evidence supported a finding that the bilateral knee condition met retention standards and the IPEB reasonably determined the condition to be not unfitting.

Contended Delayed PTSD. The CI was diagnosed with delayed PTSD following return from deployment. The CI deployed to Iraq from 7 April 2003 to 31 March 2004. On post-deployment health assessments (7 March 2004 and 2 April 2004), the CI indicated participating in combat and feeling in great danger. He indicated “no” to screening questions for symptoms of depression or PTSD. At a clinic encounter on 10 August 2005, the CI reported sleep problems since returning from Iraq. The screen for depression was indicated as “No.” The Non-Commissioned Officer Evaluation Reports (NCOER) for the periods February 2005 to October 2005 and November 2005 to May 2006 reflected excellent duty performance with recommendation for continued career progression and promotion. At the time of a periodic medical examination, in May 2006, the examiner recorded the presence of signs of PTSD and indicated referral to mental health. The NCOER for the period 1 June 2006 to 31 May 2007 again reflected excellent duty performance with recommendation for continued career progression and promotion. Service treatment records reflect treatment with medication for insomnia and participation in group therapy. The commander’s statement dated 19 December 2007 noted the CI to be an outstanding soldier and leader, only limited due to his physical conditions. The psychiatry MEB NARSUM addendum dated 11 February 2008, recorded problems with irritability, feeling edgy, exaggerated startle and sleep problems since returning from Iraq. He noted decreased patience with others, lack of empathy and lack of motivation. There was marital strain related to communication difficulties. He described frustration with the military. The CI was planning on returning to school when he left the military. On examination his mood was normal with anxious affect. Speech, thought processes, insight, judgment and cognition were normal. Suicidal or homicidal thoughts were absent. The MEB psychiatrist examiner diagnosed delayed PTSD and adjustment disorder with a Global Assessment of Functioning of 70, indicating mild symptoms and mild impairment that was not disqualifying for continued military service. The psychiatrist noted that the two mental health conditions merited a profile designation as “S1,” (meets psychiatric functionality standards), for purposes of the physical profile. The delayed PTSD and the adjustment disorder conditions were not implicated in the commander’s statement. There was no performance based evidence from the record that these conditions significantly interfered with satisfactory duty performance. After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the delayed PTSD or adjustment disorder conditions.

Contended Sleep Apnea, Hypertension and Dyslipidemia. The sleep apnea, the hypertension and dyslipidemia were evaluated by the NARSUM examining physician. The sleep apnea condition was successfully corrected with continuous positive airway pressure use for sleep. The NARSUM physician noted that the sleep apnea condition merited a P2 permanent coding for his profile and would not impact overseas deployability so long as water and electricity were available for his CPAP machine. At the MEB examination his blood pressure was normal. His cholesterol and his low density lipoproteins were mildly elevated. All were determined to meet full cardiopulmonary function retention standards. There was no performance based evidence from the record that any of these conditions significantly interfered with satisfactory duty performance. After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions (bilateral knee pain, delayed PTSD, adjustment disorder, sleep apnea, hypertension, and dyslipidemia) therefore, no additional disability ratings are recommended.


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 low back pain condition with degenerative disc disease condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication. In the matter of the contended bilateral knee pain, delayed post-traumatic stress disorder, the adjustment disorder, sleep apnea, hypertension, and dyslipidemia conditions, the Board unanimously recommends no change from the PEB determinations as not unfitting. There were no other conditions within the Board’s scope of review for consideration.


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






The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20121102, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record






                 
XXXXXXXXXXXXXXXXXX
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 XXXXXXXXXXXXXXXXXX, AR20140020540 (PD201200066)

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

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