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AF | PDBR | CY2012 | PD2012 01762
Original file (PD2012 01762.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:    CASE NUMBER: PD120 1762
BRANCH OF SERVICE: Army   BOARD DATE: 2013 0606
Separation Date: 20080207


SUMMARY OF CASE : Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SGT/E-5 (31B20/Military Policeman) medically separated for a low back condition. The CI developed atraumatic low back and right hip pain beginning in late 1998 to 1999. Despite a microdiscectomy, physical therapy, non-steroidal anti-inflammatory drugs, muscle relaxants, and epidural steroid injections (ESIs), the CI failed 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 MEB forwarded “lumbago, lumbar spondylosis L5-S1 HNP with post laminectomy syndrome” to the Physical Evaluation Board (PEB) IAW AR 40-501. The MEB also identified and forwarded patellofemoral syndrome (PFS) chondromalacia knees; hyperlipidemia, severe; borderline hypertension (HTN); and borderline glucose tolerance conditions that were judged to meet retention standards. The PEB adjudicated the “lumbar degenerative disc disease (DDD)” as unfitting, rated 20% with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD). The CI made no appeals and was medically separated.


CI CONTENTION : “Was told by the med board when I was discharged from the Army that VA would pickup all of my disabilities in the VA rating.”


 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 ratings for unfitting conditions will be reviewed in all cases. The rating for the unfitting low back condition is addressed below along with the contended conditions of: PFS, chondromalacia knees; hyperlipidemia, severe; borderline HTN; and borderline glucose tolerance. Any condition or contention either not requested in this application or otherwise outside the Board’s defined scope of review, remain eligible for future consideration by the Board for the Correction of Military Records.


RATING COMPARISON :

Service IPEB – Dated 20090217
 VA - (3 Mos. Pre -Separation)
Condition
 Code Rating Condition Code Rating Exam
Lumbar DDD 5299-5242 20% DDD Lumbar Spine w/ Lumbar Spondylosis 5242-5243 20%* 20071023
PFS Chondromalacia Knees Not Unfitting PFS Chondromalacia Left Knee 5099-5024 0% 20071023
Hyperlipidemia, Severe Not Unfitting No Corresponding VA Entry
Borderline HTN Not Unfitting Benign Essential HTN 7101 0% 20071023
Borderline Glucose Tolerance Not Unfitting Diabetes Mellitus 7913 NSC** 20071023
No Additional MEB/PEB Entries
 Other x 5 20071023
Combined: 20%
 Combined: 40%
Derived from VA Rating Decision (VARD) dated 20080422 ( most proximate to date of separation [DOS]).
*20090601 VARD increased the Spine rating to 40% effective 20081121 after VA C&P exam on 20090421 .
**20090601 VARD service connected Diabetes mellitus, type II rated at 20% effective 20080117.


ANALYSIS SUMMARY : The Disability Evaluation System (DES) is responsible for maintaining a fit and vital fighting force. While the DES considers all of the member's medical conditions, compensation can only be offered for those medical conditions that cut short a member’s career, and then only to the degree of severity present at the time of final disposition. However the Department of Veteran s Affairs , 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 V eteran’s disability rating should his degree of impairment vary over time.

Lumbar DDD Condition . There were three 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 ~ 5.43 Mo. Pre-Sep VA C&P ~ 2.87 Mo. Pre-Sep Rehab ~3.30 Mo.
Post-Sep
Flexion (90 Normal)
 55 ( 55/55/55 ) 60 , *45 45
Extension (30)
 15 ( 15/15/15 ) 30 , *20 20
R Lat Flexion (30)
 20 ( 20/20/20 ) 30 , *20 -
L Lat Flexion (30)
 20 ( 20/20/20 ) 30, *20 -
R Rotation (30)
 30 ( 30/30/30 ) 20 , *20 -
L Rotation (30)
 30 ( 30/30/30 ) 20 , *20 -
Combined (240)
 170 190 -
Comment
 Goniometer; antalgic gait favoring Rt. leg/ hip ; some tenderness to palpation (TTP) along mid lumbar spine into SI area; TTP into rt. hip with discomfort; some paravertebral spasm, flattening of lower spine with movement; limited movement from spasm/pain ; straight leg raising (SLR) Rt. 30°/Lt 90° ; no focal neuro deficit or atrophy *with pain; tenderness; leg length anterior iliac spine to medial malleolus Rt. 103cm 105 Lt.; antalgic gait; spine function additionally limited after repetitive use by pain; motor/sensory /reflexes intact Severe pain on palp ation ; localized tenderness; muscle strength n or m a l
§4.71a Rating
 20 % 20 % 20 %
invalid font number 31502
The CI’s back condition is well documented in the numerous notes in the service treatment record . X-rays of the sacro iliac joint and thoracic spine was normal; however, the LS spine X -ray showed minimal spondylosis. In August 2006 , the CI was seen for complaints of low back pain and radicular symptoms to the right leg after doing pushups and a lumbar spine X -ray noted mild degenerative changes at L5-S1. A magnetic resonance imaging demonstrated a degenerated bulging disc at L4-5, degenerated disc at L5-S1 with right sided disc protrusion. The CI was seen by n eurology for lower back pain and right leg pain and diagnosed with a herniated nucleus pulposus L5-S1 on the right. He underwent a discectomy L5-S1 in September 2006 . The CI had post operative back pain and tenderness on palpation and he was referred to a c hiropractor. The c ommander’s s tatement indicated that the CI’s medical condition severely limited his ability to perform in his MOS. The MEB n arrative s ummary (NARSUM) exam , approximately 5 months prior to separation documented that the CI had markedly severe , persistent pain in the lower back that radiated into his right hip and caused a functional impairment of an inability to lift more than 10 pounds, an inability to stand more than 15  minutes, and an inability to run, march , do physical training , or do sit-ups or pushups. The MEB NARSUM physical exam findings are summarized in the chart above. The CI was given a permanent L3 Profile for lumbago and L2 profile for PFS. A repeat lumbar spine X -ray showed DDD L 4-5 and L5-S1. The VA Compensation and Pension (C&P) exam , performed approximately 3 months prior to separation , noted constant localized pain , squeezing, aching, sticking, and cramping pain that would occur with or without activity. The CI further noted that the pain was described as constant pain and pressure that would become sharper with use. The C&P physical exam findings are summarized in the chart above. The CI continued with back pain and he was trea t ed with ESIs with a failed response .

The Board directs attenti on to its rating recommendation based on the above evidence . The PEB and the VA chose different coding options but this did not significantly affect the rating as noted above. The PEB coded the l umbar DDD as analogous to 5242 d egenerative arthritis of the spine rated at 20%. The VA coded the DDD l umbar s pine wit h s pondylosis as 5242 with 5243 i ntervertebral disc syndrome rated at 20%. The g eneral r ating f ormula for d iseases and i njuries of the s pine con siders the CI’s pain symptoms “w ith 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 f orward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees . The CI had paravertebral muscle spasm, antalgic gait , and limited ROM on flexion. 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 l umbar DDD condition.

Contended PEB Conditions. The contended conditions adjudicated as not unfitting by the PEB were PFS c hondromalacia k nees, h yperlipidemia, s evere b orderline HTN, and b orderline g lucose t olerance . The Board’s first charge with respect to these conditions is an assessment of the appropriateness of the PEB’s fitness adjudications. The Board’s threshold for countering fitness determinations is higher than the VASRD §4.3 r easonable doubt standard used for its rating recommendations, but remains adherent to the DoDI 6040.44 “fair and equitable” standard.

 The PFS c hondromalacia k nees condition was profiled and implicated in the c ommander’s s tatement, however , the MEB examiner documented normal ROM and minimal patellar grinding on stress only , and that the knee condition “did not prevent function enough to cause failure to meet retention standards. ” The MEB examiner also noted the knee s alone warranted no more than an L2 p rofile and this was also annotated on the DA Form 3349 itself. The PFS c hondromalacia k nees condition was reviewed by the a ction o fficer and considered by the Board. There was no indication from the record that th is condition significantly interfered with satisfactory duty performance.
None of the h yperlipidemia, s evere b orderline HTN , and b orderline g lucose t olerance conditions were profiled; none were implicated in the c ommander’s s tatement, and none were judged to fail retention standards. All were reviewed by the a ction o fficer and considered by the Board. There was no indication from the record that any of these conditions 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 any of the contended conditions and therefore, no additional disability ratings 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. In the matter of the l umbar DDD condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication. In the matter of the contended PFS c hondromalacia k nees, h yperlipidemia, s evere b orderline HTN, and b orderline g lucose t olerance conditions, the Board unanimously recommends no change from the PEB determinations 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
Lumbar Degenerative Disc Disease 5299-5242 2 0%
COMBINED
 2 0%


The following documentary evidence was considered:
Exhibit A. DD Form 294, dated 20 120927 , 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 AR20130016790 (PD201201762)


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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