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AF | PDBR | CY2012 | PD2012 01606
Original file (PD2012 01606.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:    BRANCH OF SERVICE: Army
CASE NUMBER: PD1201606   SEPARATION DATE: 20040111
BOARD DATE: 20130417


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SGT/E-5 (63B/Mechanic), medically separated for chronic low back pain (LBP). The CI’s symptoms began in February 1999 while running. The chronic LBP condition could not be rehabilitated and did not improve adequately with treatment to meet the physical requirements of her Military Occupational Specialty or satisfy physical fitness standards. She was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB). Left elbow pain, right knee pain, bilateral foot pain and infertility conditions, identified in the rating chart below, were also identified and forwarded by the MEB. The Physical Evaluation Board (PEB) adjudicated the chronic LBP condition as unfitting, rated 10% with application of Veteran’s Affairs Schedule for Rating Disabilities (VASRD). The remaining conditions were determined to be not unfitting. The CI made no appeals, and was medically separated.
CI CONTENTION: “Degenerative Disc Disease – I received a medical discharge for this condition. It will only get worse not better. I am constantly in pain and would like to be properly compensated for something I will have to live with for the rest of my life.”


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 condition of chronic LBP as requested for consideration meet 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 Board for Correction of Military Records.


 RATING COMPARISON :

Service IPEB – Dated 20031002 VA (1 Mo. Pre-Separation) – All Effective Date 20040112
Condition Code Rating Condition Code Rating Exam
Chronic Low Back Pain 5242 10% Degenerative Arthritis 5242 20% 20031217
Right Knee Pain Not Unfitting Infrapatellar Tendonitis, Rt Knee 5257-5014 10% 20031217
Left Elbow Pain Not Unfitting Not Addressed
Bilateral Foot Pain Not Unfitting Not Addressed
Infertility Not Unfitting Not Addressed
↓No Additional MEB/PEB Entries↓ Infrapatellar Tendonitis, Lt Knee 5257-5014 10% 20031217
Combined: 10% Combined: 40%
* Per VARD dated 20110930 combined rating changed to 5 0% effective 20110203


ANALYSIS SUMMARY: The Board acknowledges the sentiment expressed in the CI’s application regarding the significant impairment with which her service-incurred condition continues to burden her. It is a fact, however, 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. This role and authority is granted by Congress to the Department of Veterans Affairs (DVA). The DVA, operating under a different set of laws (Title 38, United States Code), is empowered to compensate service-connected conditions and to periodically re-evaluate said conditions for the purpose of adjusting the veteran’s disability rating should the degree of impairment vary over time.

Chronic Low Back Pain Condition. The first medical record entry regarding this condition was in March 2000, at which time the CI complained of severe LBP for the previous 30 days. Pain medication, physical therapy (PT) and epidural steroid injections failed to adequately improve her symptoms. Pain aggravators included running and prolonged standing. The CI described “flexion” as an action that decreased her pain. Radiographs of the lumbar spine revealed minimal disc narrowing at L4-L5 vertebral level and a magnetic resonance imaging study revealed minimal facet joint hypertrophy at L4-L5 and L5-S1 vertebral levels. The goniometric range-of-motion (ROM) evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.
Thoracolumbar ROM
(Degrees)
PT ~7 Mo. Pre-Sep
 MEB ~6 Mo. Pre-Sep VA C&P ~1 Mo. Pre-Sep
Flexion (90)
90 (110)
 90 (115) 80
Ext (0-30)
15
 10 10
R Lat Flex (0-30)
-
 30 (33) 20
L Lat Flex 0-30)
-
 30 20
R Rotation
-
 - -
L Rotation
-
 - -
Combined
-
 >185 >130
Comment
 +Painful motion; no tenderness
+Tenderness
 Normal gait
§4.71a Rating
 10% 10% 10%
At the MEB exam ination (6 months prior to separation), the CI reported LBP with running or marching after 5-10 steps, jumping 1-3 times, or standing longer than 5-10 minutes. Her walking was unlimited. Additionally, her pain increased after sitting for 30 minutes to an hour. P ain was reported as constant , with a “ normal day ” described a s 5-8 on a 0- 10 pain scale. She denied radicular symptoms. Examination revealed a normal gait and no evidence of erythema, edema, ecchymosis, or spinal deformities. The exam was silent regarding muscle spasm. Muscle strength and deep tendon reflexes (DTR) of the lower extremities were normal. The DD 2808 noted LBP in the supine position. A t the VA Compensation and Pension (C&P) exam ination ( a month prior to separation ) , the CI reported pain in her back while running. The examination revealed normal neuromuscular findings and normal spinal structure . Straight leg raise testing was “to 70 degrees bilaterally.” DTR’s were normal. There was no mention of muscle spasm or spinal contour. ROM measurements are reflected in the table; rotation was not performed, and the examiner stated that normal extension was 15 degrees and lateral flexion was 25 degrees. The examiner diagnosed lumbar spine osteoarthritis and stated that, “It does give her a moderate amount of physical impairment because of the pain in her lumbar spine. ”

The Board directs attention to its rating recommendation based on the above evidence. Although the Service and VA titled the unfitting back condition differently, they both utilized the same 5242 code (degenerative arthritis of the spine) and rated at 10% and 20% respectively. Board members agreed that the service exams showed non-compensable limitation of motion; but sufficient evidence of painful motion was present to justify the PEB’s 10% rating IAW §4.59. Although the VA noted that a 10% rating was warranted by limitation of motion IAW VASRD §4.71, a higher rating of 20% was assigned for “greater limitation of motion with increased activity.” The Board debated the application of §4.45, which allows for a higher rating if evidence of additional functional loss is present, and which appeared to be the basis for the VA’s decision. The Board concluded however that there was no examination evidence on which to base a conclusion that repetitive motion resulted in additional disability. Therefore, Board members agreed that a rating higher than 10% was not justified. 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.
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 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 Low Back Pain 5242 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




         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 AR20130010321 (PD201201606)


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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