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AF | PDBR | CY2012 | PD2012 00468
Original file (PD2012 00468.rtf) Auto-classification: Approved
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:    CASE: PD1200468
BRANCH OF SERVICE: Army  BOARD DATE: 20130409
SEPARATION DATE: 20020119


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (13E/Fire Direction Crew Member) medically separated for low back pain (LBP). Treatment records indicate the CI first reported injuring his back in 1996 while moving heavy objects. The back condition could not be adequately rehabilitated to meet the requirements of his Military Occupational Specialty (MOS) or physical fitness standards so he was issued a permanent L4 profile and referred for a Medical Evaluation Board (MEB). The back condition, characterized as “mechanical low back pain” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. No other conditions were submitted by the MEB. The PEB adjudicated “mechanical low back pain” as unfitting and rated 10%. The CI made no appeals and was medically with a 10% disability rating.


CI CONTENTION: “Situation has not improved and has impacted my ability to perform certain job functions as well as continue my service.”


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 back condition is 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 PEB – Dated 2002110
 VA - (~5 Yrs. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Mechanical Low Back Pain with L4/L5 Bulging Disc 5299-5295 10% Discogenic Lumbosacral Spine, with DJD and Chronic Lumbar Strain 5237 10% 20070223
No Additional MEB/PEB Entries
 No Additional VA Entries
Combined: 10%
 Combined: 10%


ANALYSIS SUMMARY:

Mechanical Low Back Pain. Service treatment records (STRs) indicated a history of intermittent LBP beginning in 1996, after injury sustained during loading trucks. The CI underwent physical therapy and attended back school over a 2 year period. During the 2 year period he was noted to have full range-of-motion (ROM) of lumbar spine. Approximately a year prior to separation physical medicine records recorded normal gait, use of a back brace, normal strength and normal reflexes and sensation. It was noted the CI was scheduled to be deployed and that the back brace was being tapered. The CI had a bone scan 18 October 2000 that was normal. The records are silent going forward until the MEB. The narrative summary (NARSUM) referenced a magnetic resonance imaging (MRI) study, performed in May 2001, approximately 8 months prior to separation that revealed mild L4-5 disk bulge, without evidence of nerve impingement. The commander’s statement (CS) 5 September 2001 indicated the CI had difficulties performing the duties of his MOS due to his back condition and the requirement of physical stamina and strength. His profile allowed him to walk, bike and swim at his own pace and distance and do abdominal crunches. On MEB/NARSUM evaluation, 19 March 2001, 8 months prior to separation, the CI reported he could not lift more than ten pounds without aggravating back pain. The CI related one incidence of radicular pain but indicated he had no other signs or symptoms of radiculopathy. On examination, his gait was “slightly antalgic favoring the left lower extremity. The CI could heel toe walk, and had normal sensory and strength examinations. ROM was noted as limited to 5 degrees of extension and 45 of forward flexion “with fingertips lacking 20 inches from reaching the floor” (moderate; about 50-55 degrees with goniometer). At the VA Compensation and Pension (C&P) evaluation, 23 February 2007, approximately 5 years after separation, reported daily back pain and denied radicular symptoms. The CI indicated he was working as truck driver and denied his daily occupation as a truck driver made his condition worse at the end of the day. He indicated he took no medications for pain. The CI denied use of assistive devices for ambulation and denied any gait abnormality. On examination gait and posture were noted as normal. Flexion of lumbar spine was approximated at 70 degrees, limited by pain and stiffness; extension was approximated at 30 degrees with pain and weakness noted. There was no fatigability or lack of endurance on flexion. There was no palpable tenderness and no evidence of radiculopathy.

The Board directs attention to its rating recommendation based on the above evidence. The PEB rated the condition 10% for pain on forward motion code 5295 (lumbosacral strain). The VA rated 10% limitation of forward flexion code 5237 (limitation of motion), and cited degenerative joint disease (DJD) and chronic lumbar strain. In accordance with DoDI 6040.44, the Board is required to recommend a rating IAW the VASRD in effect at the time of separation. The Board must correlate the above clinical data with the 2002 rating schedule which was in effect at the time of separation (applicable diagnostic codes include: 5292 (limitation of lumbar spine motion); 5293, (Intervertebral disc syndrome), and 5295 (Lumbosacral strain). The Board considered the rating under 5295, lumbosacral strain, and agreed there was characteristic pain on motion supporting the 10%. There is insufficient evidence to support the higher rating of 20% since there is no evidence of spasms occurring on extreme forward bending and no documented clinical evidence of spasms in any record prior to separation. The Board noted the improved ROM on C&P exam 5 years after separation, and opined this to represent improvement of the condition with time and treatment. After discussion, the Board agreed that the limitation of motion of the spine at the time of separation was moderate (flexion to 20 inches from floor is about 50-55 degrees) and would support a higher rating of 20% under code 5292. The Board considered rating under code 5293, intervertebral disc syndrome. There was no evidence of ratable peripheral nerve impairment in this case, since no motor weakness was present and sensory symptoms had no functional implication. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was sufficient cause to recommend a change in the PEB adjudication for the chronic LBP 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 chronic LBP condition, the Board unanimously recommends a disability rating of 20%, coded 5292 IAW VASRD §4.71a. There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION: The Board 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
Mechanical Low Back Pain 5292 20%
COMBINED
 20%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20120604, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record




         Physical Disability Board of Review


 SFMR-RB                                                                         


MEMORANDUM FOR Commander, US Army Physical Disability Agency
(TAPD-ZB),


SUBJECT: Department of Defense Physical Disability Board of Review Recommendation
for AR20130009526 (PD201200468)
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 rating to 20% without 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                                                 
                                                      (Army Review Boards)

CF:
( ) DoD PDBR
( ) DVA

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