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AF | PDBR | CY2012 | PD 2012 01785
Original file (PD 2012 01785.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX         CASE: PD-2012-01785
BRANCH OF SERVICE: NAVY  BOARD DATE: 20140402
SEPARATION DATE: 20020415


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Aviation Electronics Technician) medically separated for mechanical low back pain (LBP). The CI was diagnosed with polycystic kidney disease, with no loss of renal function. The kidney condition was believed to have resulted in her mechanical LBP. Despite a course of physical therapy and conservative treatment, the CI’s back condition showed no improvement and she could not be adequately rehabilitated to meet the physical requirements of the rating or satisfy physical fitness standards. She was placed on limited duty and referred for a Medical Evaluation Board (MEB). The MEB forwarded polycystic kidney disease; mechanical LBP; hypertension; iron deficiency anemia, small, hemodynamically insignificant, pericardial effusion, stable; and abdominal bruit, without evidence of renal artery stenosis, to the Physical Evaluation Board (PEB). No other conditions were submitted by the MEB. The PEB adjudicated “mechanical low back pain” as unfitting, rated 10%, with a 0% deduction for a pre-existing condition. The polycystic kidney disease and hypertension conditions were deemed Category II (conditions that contribute to the unfitting condition). The remaining MEB referred conditions were adjudicated as Category III (conditions that are not separately unfitting and do not contribute to the unfitting condition). The CI made no appeals and was medically separated.


CI CONTENTION: The CI makes no contentions.


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 mechanical LBP condition is addressed below. In addition, the board will address the Category II conditions of polycystic kidney disease and hypertension as determined by the PEB to contribute to the unfitting condition, but in and of themselves, not separately unfitting. No additional conditions are 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 Board for Correction of Naval Records.


RATING COMPARISON :

Service IPEB – Dated 20020304
 VA - (32 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Mechanical Low Back Pain 7533-5295 10% Lower Back Condition 5299-5237 NSC 20050126
Polycystic Kidney Disease Cat II Polycystic Kidney Disease 7533 30% 20050126
Iron Deficiency Not Unfitting Anemia 7700 10% 20050126
Hypertension Cat II No VA Entry
Pericardial Effusion Not Unfitting No VA Entry
Abdominal Bruit Not Unfitting No VA Entry
No Additional MEB/PEB Entries
 Other x 1 20050126
Combined: 10%
 Combined: 40%
Derived from VA Rating Decision (VA RD ) dated 200 50511 ( most proximate to date of separation [ DOS ] ).
VARD 20070906 continued the 30% rating for code 7533 and 10% for code 7700; and continued to NSC the low back condition.

ANALYSIS SUMMARY:

Low Back Mechanical Pain Condition. The CI had a long history of back pain, flank pain, abdominal pain, with costovertebral angle tenderness associated with a urinary tract and a kidney infection, possible cyst rupture and possible cyst bleeding. On 24 September 1998, an ultrasound found multiple bilateral renal cysts. She was diagnosed with polycystic kidney disease, a congenital genetic cystic disorder of the kidneys. She was evaluated by nephrology, physical therapy and orthopedics for the persisting mechanical LBP, associated with the polycystic kidney disease and aggravated by, kidney infections, cyst ruptures and cyst bleeds.

On 2 May 2000, she was seen in primary care and the note documented a 2-year history of constant mid to lower back pain for 2 years. The pain was aggravated by a motor vehicle accident on 24 April 2000. The pain was also aggravated by prolonged standing. Primary care documented that there was increased pain at the time of the examination and no numbness or tingling reported. Physical exam revealed that the CI was alert, oriented and in no visible distress. The back showed no visible or palpable abnormalities, normal reflexes, normal strength and non-tender with range-of-motion (ROM) movements. The final diagnosis was aggravation of back pain secondary to polycystic kidney disease. The case was discussed at the time by the examiner with nephrology. She was given 7 days of light duty. On 23 May 2000, she was seen for back pain by primary care. She was being treated for a kidney infection and chronic back pain. Physical exam was positive, left greater than right costovertebral angle tenderness (pain elucidated by percussion of the back overlying the kidney), no gluteal pain, full ROM and negative straight leg raise pain. She was diagnosed with back pain due to polycystic kidney disease. On a 17 July 2000 nephrology follow-up visit for polycystic kidney disease, hypertension and recent kidney cyst infection with possible cyst rupture was noted. She reported bloody urine, fevers and chills, and persistent LBP associated with lengthy periods of standing. Physical examination revealed no costovertebral angle tenderness, positive paraspinous spasm and positive left straight leg raise test. The diagnosis was status post recent cyst infection with possible cyst rupture, back pain multifactorial polycystic kidney disease and lower back spasm/strain. On 15 August 2000, she was seen by physical therapy. The note documented that the CI related a history of LBP since October 1999, which became progressively worse. She reported an episode of LBP in January. The note documented that temperature changes also caused flare-ups, especially that summer. Pain was 5/10 at rest and 8-9/10 with activities; she worked in supply and did a lot of lifting. Pain was aggravated by bending forward. Examination revealed no tenderness over the lower back, no muscle spasm, active ROM of the trunk was full in all planes, normal strength, negative straight leg raise test, tight hamstrings, tight pyriformis and tight left hip flexors. Function was described by the examiner as able to walk on toes and heels, could assume unilateral stance, could hop on one foot, unable to run but able to walk briskly, had difficulty lifting 5-10 pounds, and difficulty with prolonged sitting and walking more than 5 minutes. Diagnosis was LBP secondary to kidney disease; pain associated with muscle spasms although not present during evaluation. The narrative summary (NARSUM) dictated 11 December 2001, 4 months prior to separation, noted the CI had finished a course of physical therapy for the LBP and reported no improvement in symptomatology. She reported continuing difficulty with performing the duties of her rating based on mechanical LBP during duties, while on a limited duty board. She took no medications. The narsum noted serum chemistries, which were normal. The Joint Disability Evaluation Tracking System findings and recommended disposition work card, indicated an orthopedic addendum noted full ROM, 5/5 strength and normal neurological exam.

The Board directs attention to its rating recommendation based on the above evidence. The Board deliberations complied with the DoDI 6040.44 requirement for rating IAW the VA Schedule for Rating Disabilities (VASRD) in effect at the time of separation. Although the complications of polycystic kidney disease certainly aggravated and caused flank/back pain at one time with spasms, the episodes were transient and treatable. Daily back pain with routine lifting while on duty was the primary unfitting characteristic of the LBP condition and was reproducible by bending forward. The Board first considered VASRD codes 7533 (cystic diseases of the kidneys) -5295 (lumbosacral strain), using the VASRD rating in effect at the time of separation. The Board did not find evidence in the record of “muscle spasm on extreme forward bending, or any loss of lateral spine motion, unilateral, in standing position,” for a higher 20% rating in the CI’s favor. There was however, documented characteristic pain on motion for a 10% rating. There was no spinal limitation of motion (5292) described in the record, and there were no signs of intervertebral disk syndrome (5293), for a possible higher rating using alternate coding at the time of separation. There was no evidence of ratable peripheral nerve impairment or documentation of incapacitating episodes, which may have provided for additional or higher rating. The Board then noted code 5299 (rated analogous to) – 5237 (lumbosacral or cervical strain) used by the VA for a rating 3 years later and rated as not service-connected. VASRD code 5237 for lumbosacral or cervical strain was not in effect at the time of separation and is analogous to the older 5295 code used by the PEB for lumbosacral strain, already discussed above. 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 low back mechanical pain condition.

Contended PEB Conditions.

Hypertension: Blood pressure readings in the year 2001 were 156/96 (no medications 31 May 2001), 138/96 (23 July 2001 on blood pressure medication), 138/76 (3 August 2001), 152/101 (3 October 2001), 142/92 (9 November 2001 on two blood pressure medications), 144/86, 156/100 (on 4 December 2011). The Board discussed the hypertension condition and did not consider it to rise to the level of unfitness by specific limited duty limitations, commander’s non-medical assessment, or such evidence as end organ damage, emergent hypertension treatment, prolonged absence from duty station, or any prolonged or frequent hospitalizations for hypertension that would otherwise indicate unfitness. 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 Category II (conditions that contribute to the unfitting conditions) determination for the hypertension condition. The Board concluded therefore that this condition could not be recommended for an additional disability rating.

Polycystic Kidney Disease: The Board deliberated if the polycystic kidney disease would rise to the level of unfitness. The evidence pointed to a contribution to the LBP and aggravations of low back pain with characteristic kidney tenderness upon palpation (costovertebral angle tenderness) when having episodic exacerbations of kidney infections, cyst infections, or cyst ruptures, which is the expected medical symptomatology. There were no specific limited duty restrictions for the polycystic kidney disease that could be considered unfitting such as, renal diet requirement, requirement for frequent laboratory measurements for kidney disease or stationing only where emergent dialysis treatment is available. There were normal urinalyses done on a routine basis in the record. There was no evidence of kidney failure by serum electrolyte laboratory findings. There were no other indications of possible unfitness due to kidney disease, such as prolonged hospitalization or emergent or prolonged hospitalization for kidney failure. The Board concluded therefore, that there was no performance based evidence from the record that the polycystic kidney disease condition significantly interfered with satisfactory duty performance on a routine basis. 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 Category II determination for the polycystic kidney disease condition and so no additional disability rating is recommended.


BOARD FINDINGS: 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 low back mechanical pain condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication. In the matter of the contended hypertension and polycystic kidney disease conditions, the Board unanimously recommends no change from the PEB determinations as Category II conditions that contribute to the unfitting condition.


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 20121004, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record




                          
XXXXXXXXXXXXXXXXXX
President
Physical Disability Board of Review

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW
BOARDS

Subj: PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS

Ref: (a) DoDI 6040.44
(b) CORB ltr dtd 28 Oct 14

In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for the reasons provided in their forwarding memorandum, approve the recommendations of the PDBR the following individual’s records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy’s Physical Evaluation Board:
- XXXXXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXXXXX, former USN


                                                      XXXXXXXXXXXXXXXXXX
                                            Assistant General Counsel
                                                      (Manpower & Reserve Affairs)

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