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AF | PDBR | CY2012 | PD2012 01529
Original file (PD2012 01529.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:    CASE NUMBER: PD120 1529
BRANCH OF SERVICE: Army   BOARD DATE: 2013 0606
Separation Date: 20060602


SUMMARY OF CASE : Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated National Guard CPT/O-3 (21B/Combat Engineer) medically separated for a back condition. He was involved in a motor vehicle accident in Iraq in 2004 and did not respond adequately to non-surgical treatment, including corticosteroid injections and rehabilitation, to meet the physical requirements of his area of concentration or satisfy physical fitness standards. The CI was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB). The MEB forwarded low back pain (LBP) due to degenerative disc disease (DDD) of the lumbar spine to the Physical Evaluation Board (PEB) IAW AR 40-501. No other conditions were submitted by the MEB. The PEB adjudicated chronic back pain, due to lumbar DDD, without neurologic or electrodiagnostic abnormality as unfitting, rated 20%, with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD). The CI did not appeal the disability rating and he was medically separated. The CI petitioned the Board of Correction of Military Records (BCMR) for an administrative correction to acknowledge his disability had resulted from a combat related injury. This correction was made but it did not affect his disability disposition and he was separated.


 CI CONTENTION : “1. Brain Trauma due to vehicle collision south of Baghdad, Iraq - November 2004 2. Incontinence that has persisted since surgery at Balad -November 2004.”


 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 chronic LBP condition is addressed below. The brain trauma and incontinence conditions were not identified by the MEB or PEB and thus, they are not within the DoDI 6040.44 defined purview of the Board. These and any other condition or contention not requested in this application, remain eligible for future consideration by the BCMR.


 RATING COMPARISON :

Service Revised ADMIN PEB– Dated 20070212
 VA*- (1 Mo. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Chronic Back Pain... 5299-5242 20% Lumbar DDD, L4-L5 5242-5238 20% 20060718
No Additional MEB/PEB Entries
 Other x 4 20060718
Combined: 20%
 Combined: 30%
*Derived from VA Rating Decision (VARD) dated 20061002 (most proximate to date of separation)


ANALYSIS SUMMARY : The Board’s authority as defined in DoDI 6040.44, resides in evaluating the fairness of Disability Evaluation System fitness determinations and rating decisions for disability at the time of separation. The Board uses service and VA evidence proximal to separation in arriving at its recommendations. DoDI 6040.44 prescribes a 12-month interval for special consideration of post-separation evidence, which is probative only to the extent that it reasonably reflects the disability and fitness implications at the time of separation.

 Chronic Back Pain Condition . There were range - of - motion (ROM) evaluations in evidence, with documentation of additional ratable criteria, which the Board weighed in arriving at its rating recommendation as summarized in the chart below.

Thoracolumbar ROM
(Degrees)
 MEB ~4.77 Mo. Pre-Sep VA C&P 1.57 Mo. Post-Sep
Flexion (90 Normal)
 70 (72) 55
Extension (30)
 20 (22) 0
Right Lateral Flexion (30)
 25 20
Left Lateral Flexion (30)
 30 (35) 20
Right Rotation (30)
 30 20
Left Rotation (30)
 30 20
Combined (240)
 205 135
Comment
 ROM by PT same date: Goniometer utilized; test repeated 3x; Pain limiting ROM all directions

Antalgic gait; Walked with slight bent forward posture; Unable to heel or toe walk due to severe LBP; Negative Waddell’s; Significant bilateral paralumbar muscle spasms; very tender to palpation (TTP) over left sacroiliac joint(SIJ); Decreased light touch sensation down left posterolateral lower extremity and out into left foot; No pathological reflexes; + seated straight leg raise (SLR)L>R; supine SLR revealed significant pain, tenderness at 45° on right, increased with dorsiflexion of foot/ left at 30° with dorsiflexion of foot; Babinski signs neg; 		Posture erect w/o obvious spinal deformity; Normal gait with no assistive device ; TTP along lower lumbar paraspinal muscles to include L4 to S1; No muscle spasm; Neg SLR bilateral and Lasegue’s sign; Pain in right lower paraspinal area; ROM repetition increased complaints of pain on left side of lower back; Very guarded in trying repetitive motion which caused fatigability; No weakness, instability, incoordination or balance problems; Grimaced throughout low back ROM testing; Decreased sensation of left L4-5 dermatome; muscle strength 5/5 all extremities ; reflexes 2+ and symmetrical
§4.71a Rating
 20% 20%
invalid font number 31502
The CI had a history of back pain caused by continuous bouncing while riding during convoy mission support. He reinjured his lower back in November 2004 during a combat convoy operation in Iraq and developed constant chronic lower back pain. The CI was given a permanent L3 p rofile for chronic LBP due to DDD with restrictions of no rucking, marching , or physical training/Army Physical Fitness Training ; however, it allow ed the CI to exercise at his own pace . C omputed tomography (CT) scan performed in November 2004 showed mild DDD changes and facet hypertrophy. A lumbar spine X - ray performed in December 2004 showed mild degenerative changes and disc narrowing at L1-2 with mild sclerosis of the end pates and early osteophyte formation. A magnetic resonance imaging ( MRI ) exam on the same date demonstrated L4-5 DDD with left paracentral annular tear and mild disc protrusion causing mild neuro foraminal spinal canal stenosis on the left ; multi-level DDD was also noted . The CI was seen in o rthopedic s pine clinic where lumbar spondylosis was noted and non-ste roidal anti-inflammatory drugs and epidural steroid injections were recommended . The CI underwent a series of six epidural steroid injections within a year with poor results. The MEB n arrative s ummary (NARSUM) examination performed approximately 4 months prior to separation noted that the CI had constant pain which varied in intensity and prevented him from prolonged walking, running, going up and down stairs, walking over uneven terrain or bending and squatting. The MEB NARSUM physical exam findings are summarized in the chart above. An e lectromyelogram performed in March 2006 was a normal study . The CI was seen in follow-up by o rthopedics for the lumbar spondylosis and he wa s offered elective back surgery; however, he declined and this decision was supported by the surgeon due to the unpredictability of the success rate. The VA Compensation and Pension (C&P) examination noted that the CI had mild weakness in his left leg associated with some numbness in this left foot and in the lateral aspect of the left leg; flare-ups 1-2 times a week with pain lasting 1-2 hours, associated with excessive standing and physical exertion, sometimes he could push through it and sometimes he required rest; and sometimes squatting , driving , and walking long distances would cause pain and he would need a walking stick, heating pad , or back brace, depending on the activity. The CI reported he liked to swim and walk for recreation. He was employed as a college instructor and worked 40 hours a week. He could not stand longer than 30 minutes at a time, but did stand for a total of 4 to 6 hours a day. The C&P physical exam findings are summarized in the chart above.

The Board directs attenti on to its rating recommendation based on the above evidence . The PEB coded the chronic back pain condi tion analogous to 5242 , d ege nerative arthritis of the spine , and rated it 20%. The VA coded the DDD L4-5 as 5242 with 5238 , s pinal stenosis , rated at 20%. The PEB and VA chose different coding options but this did not affect the rating. The general rating formula for diseases and injuries of the spine considers the CI’s pain symptoms “with or without symptoms such as pain (whether or not it radiates), stiffness or aching in the area of the spine affected by residuals of injury or disease.” All exams proximate to separation met the 20% rating criteria for either muscle spasm severe enough to result in an abnormal gait or for f orward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees. After due deliberation, considering all of the evide nce and mindful of VASRD §4.3 r easonable doubt, the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the chronic 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. 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 c hronic b ack p ain 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
C hronic Back Pain 5299-5242 2 0%
COMBINED
 2 0%
invalid font number 31502

The following documentary evidence was considered:
Exhibit A. DD Form 294, dated 20 120810 , w/atchs
Exhib it 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 AR20130018152 (PD201201529)

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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