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AF | PDBR | CY2012 | PD2012 01699
Original file (PD2012 01699.rtf) Auto-classification: Approved
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:    CASE: PD1201699
BRANCH OF SERVICE: Army  BOARD DATE: 20130409
SEPARATION DATE: 20011219


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (31F10/Network Switching Systems Operator Maintainer) medically separated for mechanical low back condition. CI first noticed low back pain (LBP) on 7 August 2000 after spinal anesthesia for an elective surgical procedure. He was first seen for the pain on 14 August 2000 at the emergency room. He was seen multiple times at his troop medical clinic and had various treatments for LBP without improvement. The mechanical low back condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS) or satisfy physical fitness standards. He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB). The condition was forwarded to the Physical Evaluation Board (PEB) IAW AR40-501. No other conditions were submitted by the MEB. The Informal PEB (IPEB) adjudicated mechanical low back condition as unfitting, rated 0%, with application of the Veterans Administration Schedule for Rating Disabilities (VASRD). The CI made no appeals, and was medically separated with a 0% combined disability rating.


CI CONTENTION: “1). Elbow injury required surgery and is continuing to have problems”
         “2). Low Back- changed my life style and still causes pain”


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 mechanical low back condition is addressed below; and, no additional conditions are within the DoDI 6040.44 defined purview of the Board. 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. The Board acknowledges the CI’s information regarding the significant impairment with which his service-connected conditions continue to burden him; but, must emphasize that the Disability Evaluation System (DES) 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 Department of Veterans Affairs, operating under a different set of laws.


RATING COMPARISON :

Service IPEB – Dated 20010814
 VA - (~2 Mo. Pre-Separation)
Condition
 Code Rating Condition Code Rating Exam
Mechanical Low Back Pain with DDD L4/L5 and L5/S1 5299 5295 0% Degenerative Disc Disease L4-5 and L5-S1 with Mechanical Low Back Pain 5293 0% 20011016
No Additional MEB/PEB Entries
 Other x 4 20011016
Combined: 0%
 Combined: 0%
Derived from VA Rating Decision dated 200 11231 ( most proximate to date of separation ).


ANALYSIS SUMMARY:

Mechanical Low Back Pain with Degenerative Disc Disease (DDD) L4/L5 and L5/S1. The narrative summary (NARSUM) dated 14 June 2001 (6 months prior to separation) describes the onset of LBP after spinal anesthesia for an elective surgical procedure. Three months after that surgery, the CI was referred to the pain clinic which noted “pulling” with flexion and pain with extension to approximately 20 degrees. He received epidural injections on two occasions without relief. At the MEB exam (also 6 months prior to separation), the CI reported continued constant pain. The MEB physical exam noted tenderness and decreased range-of-motion (ROM) due to pain and also quoted formal ROM testing of the LS spine done by PT approximately a week prior to the NARSUM, which reported forward flexion to 100 degrees, extension to 20 degrees, left and right lateral flexion to 25 degrees and left and right rotation to 45 degrees. There was no comprehensive exam or mention of pain, abnormal gait, spasm or abnormal contour in the PT exam. At an MEB orthopedic specialty examination also in June 2001 it was noted that CI’s pain level was 4/10 on average, that he was unable to lift or run, and unable to sit for more than 30 to 45 minutes or stand more than 15 minutes. He was unable to wear a Kevlar helmet, load bearing equipment (LBE), and was significantly restricted in terms of physical training with his unit. He denied any radicular symptoms or leg symptoms but complained of stiffness after long car trips. Lumbar ROMs were recorded as follows: flexion 45 degrees with pain, extension 20 degrees with severe pain, and right and left lateral flexion 10 degrees with pain. There was no lumbar spasm noted. Imaging studies included lumbosacral spinal X-rays that were read as normal, and magnetic resonance imaging (MRI) of the lumbosacral spine which showed mild disk bulges at L4-L5 and L5-S1 without spinal stenosis.

At the VA Compensation and Pension (C&P) exam performed approximately 2 months prior to separation, the CI reported that he found that his condition did not interfere with activities of daily living, bending, running or walking. Physical exam showed normal lumbosacral curvature without paraspinal muscle spasm. The examiner stated “the range of motion is within normal limits and occurs without restriction or pain. … There is no pathology to render a diagnosis.” Multiple years remote from separation (effective April 2011) the VA increased the back rating based on exams in 2011.

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 2001 VASRD standards for the spine were in effect at the time of separation. The Board must correlate the above clinical data with the 2001 rating schedule (applicable diagnostic codes include: 5292 (lumbar spine limitation of motion), 5293 (intervertebral disc syndrome); and 5295 (lumbosacral strain). The PEB coded mechanical LBP with DDD analogously as 5299-5295 and rated it at 0% specifying that there were no focal neurological deficits and no indication for a surgical intervention, and stating “it is noteworthy that Flexion is 100 degrees.” Citing the fact that the CI was essentially asymptomatic with a normal exam, the VA also rated the condition at 0%, but using code 5293. Although the Board acknowledged that thoracolumbar flexion was found to be limited on examination, in May 2011, where the VA then raised its disability rating to 20% based on this finding, such symptoms were not demonstrated to be present at the time of separation. Although the VA exam mentions full ROM and the VA describes the ROMs as being without evidence of pain or spasm, orthopedic specialty exam done as part of the MEB described painful motion in all directions, and the PT exam (with forward flexion of 100 degrees) noted slight limited extension and lateral flexion. It is obvious that there is a clear disparity between these examinations, with significant implications regarding the Board's rating recommendation. The Board thus carefully deliberated its probative value assignment to these conflicting evaluations, and carefully reviewed the file for corroborating evidence. The Board considered that the exam performed by an orthopedic specialist had a high level of probative value. The Board considered that the MEB exam of decreased pain-limited motion and the PT exam with slight decreased extension and lateral flexion measurements supported application of VASRD §4.7 (higher of two evaluations) for a rating of 10% rather than the 0% evaluation based on the VA exam, which may have been on “a good day” for a condition which is known to vary from day-to-day. The Board concluded that based on the orthopedic evaluation, or the slight limited extension of the PT exam, the condition would qualify for the 10% rating under 5295 based on characteristic pain on motion, or 5292 for slight limited motion, or a minimum 10%, with application of §4.59 (painful motion). As all exams documented slight limited motion in some axis of movement, the Board considered code 5292 at 10% predominated. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the 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 low back condition, the Board unanimously recommends a disability rating of 10%, 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 with Degenerative Disc Disease L4/L5 and L5/S1 5292 10%
COMBINED
 10%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20120611, 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 AR20130009103 (PD201201699)
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 10% 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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