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AF | PDBR | CY2012 | PD2012 01126
Original file (PD2012 01126.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: xxxxxxxxxxxxxxxxx  CASE: PD1201126
BRANCH OF SERVICE: Army  BOARD DATE: 20130822
SEPARATION DATE: 20011203


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SSG/E-6 (14E/Patriot Fire Control Operator) medically separated for a low back condition. The CI began having back pain after a parachute jump and a hard landing in 1995. The pain continued to get worse despite coming off jump status and often worsened with physical activities. The back condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty. He was issued a permanent L3 profile which allowed for alternate aerobic events to satisfy physical fitness standards, and was referred for a Medical Evaluation Board (MEB). The MEB forwarded chronic low back pain (LBP), spondylolysis at L5, stable on X-rays, degenerative disc disease between L5-S1, chronic retro patellar pain syndrome (RPPS) and episodic sciatica on the right and left to the Physical Evaluation Board (PEB) IAW AR 40-501. No other conditions were submitted by the MEB. The PEB adjudicated chronic LBP to include mild compression fracture of T12-L1, degenerative lower lumbar disc disease as unfitting, rated 10%, with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD). The chronic RPPS and episodic sciatica on the right and left were determined to be not unfitting . The CI made no appeals, and was medically separated .


CI CONTENTION: “Military discharged me with a rating of 10% (code 5295); VA rated me for back under 5243 (10%); 30% PTSD; retropatellar pain syndrome (10%); right ankle 0%”


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 ratings for the unfitting back; and not unfitting and contented RPPS condition are addressed below. The unfitting sciatica was not contended; and, thus is not within the DoDI 6040.44 defined purview of the Board. The contended posttraumatic stress disorder and right ankle conditions were not identified by the MEB or PEB, and thus are not within the Board’s purview. These, and any other condition or contention not requested in this application, remain eligible for future consideration by the Board for Correction of Military Records.

The Board acknowledges the CI’s Department of Veterans Affairs (DVA) information regarding his service connected conditions; but, must emphasize that 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 DVA, operating under a different set of laws.


RATING COMPARISON :

Service IPEB – Dated 20011102
 VA* - Service Treatment Records (STR)
Condition
 Code Rating Condition Code Rating Exam
Chronic Low Back Pain with Mild Compression Fracture of T12-L1 and Degenerative Lower Lumbar Disc Disease 5295 10% DDD L5-S1 with Spondylolysis 5293 10% STR
Chronic Retropatellar Pain Syndrome Not Unfitting Retropatellar Pain Syndrome; s/p Arthroscopy w/Residuals, Old Tear and Lateral Meniscus with Laxity or Lateral Collateral Ligament, Right Knee 5299-5257 10% STR
19930224
Episodic Sciatica on the Right and Left Not Unfitting No VA Entry
No Additional MEB/PEB Entries
 Other x 9 STR
Rating: 10%
 Combined: 20%
* Derived from VA Rating Decision (VARD) dated 20020131 (most proximate to date of separation)


ANALYSIS SUMMARY:

Chronic Low Back Pain. The first entry in the service treatment record (STR) is found on 7 April 1995 when the CI was seen for back pain with 7 days of duration. The CI landed on his back, knocking the wind out of himself, during airborne operations (ABN OPS) parachute jump. He had increased pain with running; pain was 5 out of 10 of the lower back with no radiation and no weakness. Physical exam revealed tenderness at the midline upper back, full range-of-motion (ROM) with pain radiating up back when bending to the right. He was diagnosed with a lumbar strain, and profiled for 72 hours of no ruck, running at own pace for 7 days, and no ABN OPS for 7 days. An X-ray performed on 26 April 1995 showed bilateral spondylosis without spondylolisthesis and spina bifida occulta (a congenital malformation). He was referred to physical therapy (PT) and neurosurgery. The back pain did not improve and he was not a surgical candidate. He was given a permanent lower extremities L3 profile which limited walking/running at his own pace, no backpack, marching up to 1 mile, lifting up to 25 pounds and no sit-ups. His commander’s statement remarked that the CI’s injuries prevented him from performing his military duties as a fire control platoon sergeant in a combat arms unit. On the narrative summary dated 15 October 2001, 2 months prior to separation, the CI stated he had pain during physical activity, gradually worsening. Pain was aggravated by doing sit-ups, running, lifting, road marching, jumping, marching in formation, tying his shoes, standing or sitting for long periods of time, and bending. Physical examination revealed normal posture and gait, some tenderness of the left posterior superior iliac spine, lateral ileum and left paraspinal muscles. ROMs were normal forward flexion, with mild pain, normal hyperextension, with little or no discomfort and normal twisting and side bending without discomfort. There was negative straight leg raising tests, negative Lasegue’s sign for radiculopathy, and normal sensation, reflexes, and motor examination noted. Magnetic resonance imaging (MRI) of the lumbar spine performed on 4 June 2001 showed irregularity involving the pars interarticularis at L5 level, L4-L5 and L5-S1 posterior disc bulges. Lumbar spine X-ray flexion and extension views showed bilateral spondylolysis of L5, no spondylolisthesis and normal range of motion. The VA rating decision was based on the STR so there was no proximate VA examination to the date of separation.

The Board directs attention to its rating recommendation based on the above evidence. The Board considered VASRD diagnostic code 5295 (lumbosacral strain) used by the PEB for a 10% rating. The Board noted that there was no level of impairment in the STR that could be considered for a higher 20% adjudication, such as muscle spasm on extreme forward bending, or loss of lateral spine motion, unilateral, in standing position. There was evidence of characteristic pain on motion for a 10% rating. The Board also considered code 5293 (intervertebral disc syndrome), used by the VA for a 10% rating based on the STR. The Board did not find evidence of moderate recurring attacks for a higher adjudication. 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 chronic low back pain condition.

Contended PEB Condition (Retropatellar Pain Syndrome). The first entry in the STR noting this condition occurred during his first active duty tour, was on 31 May 1989 for left knee pain when running; followed by right knee pain when running on 8 September 1989. On an orthopedic consultation on 3 January 1992, the CI gave a history of a previous motorcycle accident, with knee injuries in 1986 without significant problems. He was referred to PT. The right knee was much worse than the left and he had a right knee arthroscopy for a partial ACL tear on 10 April 1992. On 11 May 1993, the CI obtained a 10% VA rating due to this injury and surgery after discharge from his first tour. He recovered well and continued to have multiple injuries of the right, left, and bilateral knees during his second and last active duty tour. A left knee MRI done on 4 June 2001, showed a small Baker’s cyst. On 3 July 2001, the CI was evaluated by orthopedics and diagnosed with retropatellar pain syndrome right knee and left knee medial collateral sprain. He was given a 6-week profile to run at own pace and distance, and referred to PT. The knee conditions were not mentioned on the permanent profile or the commander’s duty performance evaluation letter, which mentioned the CI was always an above average performer on his physical fitness tests. 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 contended retropatellar pain syndrome condition and no additional disability rating was 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 Veterans Affairs Schedule for Rating Disabilities (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 and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication. In the matter of the contended RPPS condition, the Board unanimously agrees that it cannot recommend it for additional disability rating.


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

UNFITTING CONDITION
 VASRD CODE RATING
Chronic Low Back Pain Condition 5295 10%
COMBINED
 10%



The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20120612, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record





xxxxxxxxxxxxxxxxxxxxx, DAF
President
Physical Disability Board of Review


SFMR-RB                                                                         


MEMORANDUM FOR Commander, US Army Physical Disability Agency
(TAPD-ZB / xxxxxxxxxxxxx), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557


SUBJECT: Department of Defense Physical Disability Board of Review Recommendation for xxxxxxxxxxxxxxxxxxxxxx, AR20130021917 (PD201201126)


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                                                  xxxxxxxxxxxxxxxxxxxxxxxxxxxx
                                                      Deputy Assistant Secretary
                                                      (Army Review Boards)

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