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AF | PDBR | CY2012 | PD2012 01929
Original file (PD2012 01929.rtf) Auto-classification: Approved
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:    CASE: PD1201929
BRANCH OF SERVICE: Army  BOARD DATE: 20130425
SEPARATION DATE: 20030605


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SGT/E-5 (56M/Chaplain Assistant) medically separated for a low back pain (LBP) condition. The CI developed LBP as a result of an obstacle course exercise while in Advanced Individual Training (AIT). She was treated conservatively and eventually placed on restrictive permanent profile with a Medical Evaluation Board (MEB) initiated in 1996. The Physical Evaluation Board (PEB) at that time found her fit for duty, with restrictions of a permanent L3 profile. Eventually the CI’s low back condition could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty (MOS) or satisfy physical fitness standards and she was again referred for a MEB. The LBP condition, characterized as “chronic mechanical low back pain” was forwarded to the PEB IAW AR 40-501. No other conditions were submitted by the MEB. The PEB adjudicated chronic mechanical LBP as unfitting, rated 10% with likely application of the Veteran’s Affairs Schedule for Rating Disabilities (VASRD). The CI made no appeals, and was medically separated with a 10% disability rating.


CI CONTENTION: “Diagnosis of mild scoliosis, spina bifida occulta, carrying of heavy armor, IOW crawling, down loading and loading of field equipment such as tents, boxes, jumping during physical fitness, running, road marching, and all that pertained to soldering over the course of 8 ½ years created extensive wear & tear on my overall back care. I suffer chronic spasms, and constant aid in day to day activity to operate as a person. I have to depend on muscle relaxers and narcotics to help my body shift to it’s proper positioning. There’s increase of leg pain, numbness and feet pain which radiates from my back to my legs.


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 mechanical LBP condition 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. The Board acknowledges the CI’s information regarding the significant impairment with which her service-connected condition continues to burden her; 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. 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.


RATING COMPARISON :

Service IPEB – Dated 20030324
 VA - (STR)
Condition
 Code Rating Condition Code Rating Exam
Chronic Mechanical Low Back Pain 5299-5295 10% Chronic Mechanical Low Back Pain 5295 20% STR
No Additional MEB/PEB Entries
 Other x 6 STR
Combined: 10%
 Combined: 30%


ANALYSIS SUMMARY: N/A

Chronic Mechanical Low Back Pain Condition. The CI injured her back while performing the obstacle course while in AIT. She was placed on restrictive temporary profiles for a year for mechanical LBP. Orthopedics evaluated her and upgraded the profile to a permanent status in 1996 and a subsequent PEB found her fit for duty within the confines of this profile. She continued to have increasing back pain with use of her protective gear, her MOS duties and with field work. She received chiropractic and physical therapy treatment which did not significantly improve her condition. She was seen by Physical Medicine Rehabilitation (PM&R) and was recommended a more restrictive profile and a pain clinic referral for right greater than left sacroiliac (SI) joint dysfunction. The profile limitations included no lifting greater than 10 pounds, no running, jumping or marching, and any sit-ups, push-ups, or use of professional gear. She was able to perform the walk event for physical fitness testing. The commander’s statement corroborated her medical condition and additionally documented the profile prevented her from carrying a weapon, wearing a helmet, or wearing a flack vest.

At the MEB exam, the CI additionally reported marked difficulty performing repetitive jumping,
stooping, and overhead activities. She could climb up four levels of stairs with periodic rest, sit for 30 minutes, stand for 30 minutes, and walked for a quarter of a mile after which her feet would go numb. The MEB physical exam demonstrated, tenderness to palpation, mild muscle spasms in the low-to-mid lumbar area, and there was a decreased lumbar lordosis. She had no tenderness at the trochanters or at the sciatic notch. Neuromuscular findings of the lower extremities were unremarkable. X-rays of the lumbar spine and SI joint were normal. The CT scan of the lower back revealed L3-4 mild ligamentum flavum hypertrophy and L-5, L5-S1 annular disc bulges which had no clinical significance. The examiner diagnosed mechanical LBP, chronic with ligamentous-type presentation of poor mobility in the lower lumbar area which had not been responsive to maximal therapy. The PM&R consult exam additionally documented electromyogram (EMG) testing with nerve conduction testing specifically for the tibial nerve was normal. She underwent a pain clinic evaluation and declined injections. The CI was offered a VA Compensation and Pension (C&P) exam but due to time constraints, the CI requested the VA rate her case without an exam.

The Board directs attention to its rating recommendation based on the above evidence. The PEB and VA based their rating recommendations IAW 2002 VASRD coding and rating standards for the spine, which were in effect at the time of separation, were modified on 23 September 2002 to add incapacitating episodes (5293, Intervertebral disc syndrome), and then changed to the current §4.71a rating standards on 26 September 2003. The older standards were based on the rater’s opinion regarding degree of severity, whereas current standards specify certain rating thresholds, with measured degrees of ROM impairment. IAW DoDI 6040.44, the Board must use the VASRD coding and rating standards which were in effect at the time of the CI’s separation. For the reader’s convenience, the 2002 rating codes under discussion in this case are excerpted below.


 5292 Spine, limitation of motion of, lumbar:
 Severe ………………………………………………………..……….………….... 40
Moderate …………………………………….……………….…….…………... 20
Slight ………………………………………………………..…………………...….10
5293 Intervertebral disc syndrome:
 Pronounced; with persistent symptoms compatible with: sciatic
 neuropathy with characteristic pain and demonstrable muscle
spasm, absent ankle jerk, or other neurological findings appropriate
to site of diseased disc, little intermittent relief ………………..….……….….. 60
 Severe; recurring attacks, with intermittent relief ……………..…….………..….…40
Moderate; recurring attacks ……………………………….……………............…... 20
Mild ……………………………………………………………..…………….….… 10
Postoperative, cured …………………………………….………..……………....….. 0
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
With slight subjective symptoms only ……………………...…….…………...…… 0

The PEB assigned a 10% rating coded analogous to 5295 (lumbosacral strain) for normal range-of-motion (ROM) with pain which is consistent with that code. The VA assigned a 20% rating coded 5295 for the presence of spasms. The Board carefully reviewed the 20% rating for the 5295 code and notes the MEB evidence supports spasm and lacks ROM ratable data. The Board carefully reviewed the service file for corroborating evidence in the 12-month period prior to separation and found evidence 10 months prior to separation in a physical therapy record documenting normal gait, normal heel and toe walk, full active rom, and silent to spasm or painful motion. The Board did not find evidence to meet the 20% higher rating under the 5292 or the 5295 code. The Board considered the 5293 code and while there is radiographic evidence of disc disease which likely caused the intermittent spasms there is no stenosis or nerve root impingement and a normal EMG. Therefore the Board agreed there is no evidence of ratable peripheral nerve impairment additional or higher rating nor is there evidence of or incapacitating episodes. The Board notes there is a reasonable amount of evidence reflecting the inability to perform the duties of her MOS due to increasing pain and intermittent spasms likely due to multi factorial back pathologies, ligamentous and disc disease, which supports the VASRD §4.40 (functional loss). The Board also considered VASRD §4.7 (higher of two evaluations) during its deliberation which directs the evaluator to assign the higher of two valid ratings if the disability picture more nearly approximates the criteria. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 20% as a fair permanent separation rating for the chronic mechanical LBP 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 mechanical LBP condition, the Board unanimously recommends a disability rating of 20%, coded 5293-5295 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 her prior medical separation:

UNFITTING CONDITION
 VASRD CODE RATING
Chronic Mechanical Low Back Pain 5293-5295 20%
COMBINED
 20%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20120604, 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 AR20130009566 (PD201201929)
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 20% 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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