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AF | PDBR | CY2012 | PD2012 01166
Original file (PD2012 01166.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:   BRANCH OF SERVICE: Army
CASE NUMBER: PD1201166   SEPARATION DATE: 20030104
BOARD DATE: 20130417


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SSG/E-6 (93C, Air Traffic Control Operator), medically separated for chronic mechanical low back pain. The CI has a history of back pain that began when he injured his back playing basketball in 1995. He underwent conservative treatment to include physical therapy but continued to experience back pain. The CI did not improve adequately and was unable to meet the physical requirements of his Military Occupational Specialty (MOS) of satisfy physical fitness standards. He was issued a permanent L3 profile and was referred for a Medical Evaluation Board (MEB). The MEB forwarded no other conditions for PEB adjudication. The PEB adjudicated the chronic back pain condition as unfitting, rated 10% with application of the Veteran’s Affairs Schedule for Rating Disabilities (VASRD). The CI made no appeals, and was medically separated with a 10% disability rating.


CI CONTENTION: “Review of DoD disability rating to ensure accuracy and fairness.”


SCOPE OF REVIEW: The Board wishes to clarify that the scope of its review as defined in DoDI 6040.44, Enclosure 3, paragraph 5.e.(2) is limited to those conditions which were determined by the PEB to be specifically unfitting for continued military service; or, when requested by the CI, those condition(s) “identified but not determined to be unfitting by the PEB”. The Service ratings for unfitting conditions will be reviewed in all cases. The Service rated condition chronic mechanical low back pain, as requested for consideration, meets the criteria prescribed in DoDI 6040.44 for Board purview; and, 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 Army Board for the Correction of Military Records.


RATING COMPARISON :

Service PEB – Dated 20020912
 VA (2 Mos. Pre-Separation) – All Effective Date 20030105
Condition
 Code Rating Condition Code Rating Exam
Chronic Mechanical Low Back Pain 5299-5295 10% Chronic Mechanical Low Back Pain with Deg. Disc Disease 5295 10% 20021115
↓No Additional MEB/PEB Entries↓
 Obstructive Sleep Apnea 6847 30% 20021115
Left Knee, Lateral Meniscal Tear 5099-5024 10% 20021115
0% X 2 / Not Service-Connected x 1 20021115
Combined: 10%
 Combined: 40%


Chronic Mechanical Low Back Pain Condition. Beginning in June 2001, the CI sought care for chronic intermittent low back pain. The CI reported a two year history of back pain following a fall while playing basketball.

X-rays of the lumbosacral spine on 21 September 2001 were normal. An exaggerated lumbar lordosis was noted. A computer axial tomography (CT) scan 22 January 2002 was normal except for mild arthritic changes at the facet joints.
At the time of the orthopedic MEB evaluation 11 March 2002, the CI reported back pain exacerbated by prolonged running, jumping, lifting greater than 20 lbs, carrying a rucksack and wearing a flak vest. He noted only infrequent radiation of pain distally to the right hamstring above the knee. He denied sensory loss, weakness, bowel or bladder incontinence. Medications and physical therapy provided only temporary symptom relief. On examination, the range motion was flexion 70 degrees, extension 10 degrees, and lateral flexion of 40 degrees bilaterally. The spine was straight with mildly increased lumbar lordosis. There was diffuse tenderness to palpation. Straight leg raising was negative for radicular signs and strength, reflexes and sensation were normal. The orthopedic surgeon concluded that it was unlikely that any treatment in the future would allow the CI to reach a level consistent with active duty service, however his prognosis for civilian employment was excellent.

At the VA compensation and pension (C&P) examination 15 November 2002, approximately two months before separation, the CI reported low back pain that comes and goes, associated with overuse activities. He noted occasional pain into the right leg. There were no bowel or bladder changes. The CI reported stretching or taking Motrin to relieve the pain. On physical examination gait and posture were normal. The lumbar spine was non-tender to palpation and there was no muscle spasm present. The increased lordosis was noted.
After five repetitions, back flexion was 85 degrees, extension 25 degrees, lateral flexion 28 degrees to both sides, right rotation 45 degrees, and left rotation 40 degrees. There was pain reported with motion. Strength, reflexes and sensation were normal. Diagnosis was chronic mechanical low back pain secondary to mild degenerative disc disease.

The Board directs attention to its rating recommendation based on the above evidence. 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 notes that the 2002 VASRD standards for the spine, which were in effect at the time of separation, were changed to the current §4.71a rating standards in 2004. The Board must correlate the above clinical data with the 2002 rating schedule (applicable diagnostic codes include: 5292 limitation of lumbar spine motion; 5293 intervertebral disc syndrome; and 5295 lumbosacral strain). The Board first considered the rating under the VASRD diagnostic code 5292 in effect at the time. All Board members agreed the limitation of motion on both examinations did not approach the moderate level and more nearly approximated the slight level with a 10% rating. Although there was occasional radiation of pain there was no evidence of intervertebral disc syndrome to warrant consideration of rating under that code (5293). Finally, the Board considered the rating under the VASRD diagnostic code 5295 used by the PEB and the VA. There was characteristic pain on motion to support the 10% rating. There was no evidence of spasm on forward bending or loss of lateral bending or other features to support a higher rating. There is no documentation to support rating for radiculopathy with only intermittent complaints of pain in the right leg without evidence for weakness, atrophy, sensory or motor loss and no objective signs on physical examination. The Board noted the PEB included “low thoracic pain” as part of the back pain condition and that the VASRD provides for a dorsal spine (thoracic spine) limitation of motion rating when the condition is distinct from the lumbar spine condition. Review of service treatment records indicates that the areas of pain and tenderness were contiguous, and that the range of motion examinations included thoracic motion. Any impairment from the lower thoracic region was subsumed in the overall rating for the back. A separate rating for the lower thoracic spine would be based on the same impairment and is prohibited by §4.14 (avoidance of pyramiding; two ratings based on the same disability are prohibited). 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 mechanical low back pain 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.

In the matter of the chronic mechanical low back pain 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 recharacterization of the CI’s disability and separation determination, as follows:

UNFITTING CONDITION
 VASRD CODE RATING
Chronic Mechanical Low Back Pain 5299-5295 10%
COMBINED
 10%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20120719, 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 AR20130010372 (PD201201166)


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                                                 
                                                      (Army Review Boards)

CF:
( ) DoD PDBR
( ) DVA

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