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AF | PDBR | CY2012 | PD2012 01719
Original file (PD2012 01719.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:    BRANCH OF SERVICE: Army
CASE NUMBER: PD1201719   SEPARATION DATE: 20020815
BOARD DATE: 20130604


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (11B10/Infantryman) medically separated for a lumbar/sacroiliac spine condition. He developed atraumatic low back pain in 2000, which was diagnosed as degenerative disc disease (DDD) with left sacroiliac dysfunction. The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards. He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB). Two conditions, facet arthropathy and chronic left sacroiliac joint dysfunction pain, were forwarded to the Informal Physical Evaluation Board (IPEB) as medically unacceptable IAW AR 40-501. A third condition, right iliotibial band syndrome, was identified by the MEB and forwarded as meeting retention standards. No further conditions were submitted. The IPEB consolidated the facet and sacroiliac submissions as a single unfitting condition, rated 10%, and determined that the iliotibial band syndrome (ITBS) was not unfitting. The CI appealed to a Formal PEB (FPEB) which arrived at equivalent rating and fitness determinations, with a change in nomenclature and coding of the unfitting condition. It was characterized as chronic low back and hip pain with left sacroiliac dysfunction and [L5] sacralization and rated 10% under criteria of the Veterans Affairs Schedule for Rating Disabilities (VASRD) in effect. The CI made no further appeals, and was medically separated.
CI CONTENTION: “I was rated 10% disabled by the US Army PEB and was immediately, medically discharged. The VA rated me at 30% disabled better summarizing the level of disability brought upon me by the injury that was sustained while serving the US Army. ... I contend that the decision not to include by back issues with the issues created by my back issues (iliotibial band syndrome and pain., sacroiliac joint pain/numbness) were detrimental in looking at the entire disabling nature of my medical condition. ... Therefore, I should have been rated 30% + since I was provided no option to continue service in any other capacity. ... I wanted a career in the military, but this injury thwarted this desire and confined me to limited civilian career options too.”


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 lumbar/sacroiliac spine condition is addressed below; as is the requested ITBS determined to be not unfitting by the PEB. 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 FPEB – Dated 20020625
 VA - Based on Service Treatment Records (STR)
Condition
 Code Rating Condition Code Rating Exam
Chronic Low Back and Hip Pain ... Sacroiliac Dysfunction 5294-5295 10% Lumbar Disc/Sacroiliac Disease 5292 10%* STR
R Iliotibial Band Syndrome Not Unfitting R Iliotibial Band Syndrome 5314 NSC STR
No Additional MEB/PEB Entries↓
 0% X 1 / NSC (Not Service Connected) x 8 STR
Combined: 10%
 Combined: 10%
Derived from VA Rating Decision (VARD) dated 20030909 ( most proximate to date of separation [DOS]).
* R ating increased to 20% by VARD dated 20050518 , based on VA and civilian evidence from 2003 – 2004 .


ANALYSIS SUMMARY: The Board acknowledges the impairment with which the CI’s service-connected conditions continue to burden him but notes 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 Department of Veterans Affairs (DVA), operating under a different set of laws. The Board considers DVA evidence proximate to separation in arriving at its recommendations and, DoDI 6040.44 prescribes a 12-month interval for special consideration to post-separation evidence. Post-separation evidence is probative to the Board’s recommendations only to the extent that it reasonably reflects the disability at the time of separation. The Board likewise acknowledges the CI’s contention for a condition determined to be not unfitting by the PEB, but emphasizes that disability compensation may only be offered for those conditions that cut short the member’s service career. Should the Board judge that the contested condition(s) were most likely incompatible with duty requirements, a disability rating IAW the VASRD, and based on the degree of disability evidenced at separation, will be recommended.

Low Back Condition. The service treatment record (STR) identifies an onset of left lower back pain without injury in September 2000 after doing some heavy exercises. Initial complaints were confined to the back, but a left sacroiliac component surfaced within a couple of months. There were left lower radicular symptoms, but no hip complaints. Imaging identified degenerative disk and facet disease at the L4/5 level, without disc bulge or neural compromise (non-surgical). A bone scan was normal, as were electrophysiologic studies for left radiculopathy. For the 2 years preceding separation, the CI underwent a protracted trial of treatment measures which included physical therapy, sacroiliac injections, facet blocks, chiropractic manipulations, transdermal nerve stimulation, various medications, and temporary profiles. There are multiple STR entries documenting normal gait, normal neurological findings, and grossly normal range-of-motion (ROM). There is one reference to “decreased” ROM, and several entries documenting painful ROM. The narrative summary (NARSUM) described the pain as “achy, graded at 8/10, nonradiating, located at the left lower lumbar paraspinals and at the left sacroiliac joint region ... worse with back extension, standing or sitting too long, with running, push-ups, and sit-ups.” The NARSUM did not identify hip pain and documented the absence of neurological symptoms. The physical exam documented a normal gait and normal neurological findings. The back exam was recorded as “full range of motion, but pain with extension; tender to palpation at left lumbar lower paraspinals and left sacroiliac joint region.” The earliest VA spine examination was nearly 3 years after separation; thus there is no significantly probative (as explained above) post-separation evidence.

The Board directs attention to its rating recommendation based on the above evidence. The 2002 VASRD coding and rating standards for the spine, which must be applied to the Board’s recommendation IAW DoDI 6040.44, differ significantly from the current §4.71a general rating formula for the spine. The applicable coding options for this case are excerpted below.
5292 Spine, limitation of motion of, lumbar
Severe ...................................................................................................................................... 40        
Moderate ................................................................................................................................. 20            
Slight ........................................................................................................................................ 10
5294 Sacro-iliac injury and weakness [directs rating to 5295]
5295 Lumbosacral strain:
Severe; with listing of whole' spine to opposite side, positive Goldthwaite's sign,
marked limitation of forward bending in standing position, loss of lateral motion
with osteo-arthritic changes, or narrowing or irregularity of joint space, or some
of the above with abnormal mobility on forced motion ...................................................... 40
With muscle spasm on extreme forward bending, loss of lateral spine motion, unilateral,
        in standing' position ............................................................................................................. 20
With characteristic pain on motion ......................................................................................... 10
The only remaining code available in the 2002 VASRD schedule was 5293 (intervertebral disc syndrome), which is neither clinically applicable nor favorable to rating in this case. The FPEB’s 10% rating, coded 5294-5295, is supported by painful motion; criteria for the higher ratings were not in evidence. This rating subsumes the lumbar spine and sacroiliac components. The FPEB’s source for adding hip pain to the nomenclature is not clear, although it is clear that there is no separately ratable hip disability. The VA rating under 5292 referenced “slightly limited motion of the lumbar spine”, although the evidence cited full ROM. That notwithstanding, painful motion would also support the minimum 10% rating under 5292. There is no route to a rating higher than 10% supported by the evidence, and no evidence of peripheral nerve impairment for additional rating. 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 of the lumbar/sacroiliac spine condition.
Contended Right Iliotibial Band Syndrome. The CI first complained of right knee pain 6 months prior to separation, without instability, cartilage impingement, or ROM impairment on exam. The NARSUM documented the above diagnosis, and the examiner judged that the condition did not fail retention standards. The condition was never profiled, and it was not implicated in the commander’s statement. The Board’s first charge with respect to this condition is an assessment of the appropriateness of the PEB’s fitness adjudication. The Board’s threshold for countering fitness determinations is higher than the VASRD §4.3 (reasonable doubt) standard used for its rating recommendations, but remains adherent to the DoDI 6040.44 “fair and equitable” standard. This condition was reviewed by the action officer and considered by the Board. There was no performance based evidence from the record that it significantly interfered with satisfactory duty performance. 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 right ITBS, and accordingly no disability rating can be 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 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 lumbar/sacroiliac spine condition and IAW VASRD §4.71a in effect, the Board unanimously recommends no change in the PEB adjudication. In the matter of the contended right ITBS, the Board unanimously recommends no change from the PEB determination as not unfitting. 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 with Left Sacroiliac Dysfunction 5294-5295 10%
Right Iliotibial Band Syndrome Not Unfitting
COMBINED
 10%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20120730, 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 AR20130016386 (PD201201719)
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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