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AF | PDBR | CY2012 | PD2012 01959
Original file (PD2012 01959.rtf) Auto-classification: Approved
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:    CASE: PD1201959
BRANCH OF SERVICE: Army  BOARD DATE: 20130425
SEPARATION DATE: 20030725


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (37F/Psychological Operations Specialist) medically separated for a low back pain (LBP) condition. The CI’s back pain began in 2001 after he fell into a hole during training with his deployed unit in Afghanistan. He initially deferred treatment during his deployment, but his symptoms persisted and were aggravated by a run with his unit post deployment. The CI underwent physical therapy (PT) and conservative treatment for his back pain, declining an epidural injection to assist with pain control. The CI was not deemed a surgical candidate. Eventually, the LBP 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 LBP condition, characterized as “mild to moderate, associated with L4-L5 mild degenerative disc disease” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. No other conditions were submitted by the MEB. The PEB adjudicated “LBP, mild to moderate, with normal range-of-motion (ROM) and strength as unfitting, rated 0% with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD). The CI made no appeals, and was medically separated.


CI CONTENTION: “Since the original date of separation from service the condition to which l was separated has steadily worsened and my previous attempts at having my rating of 10% reviewed for increase has been unsuccessful. The last rating review was denied increase due to documentation being sent to me on December 11, 2008 which was unfortunately never received and subsequently not returned. I believe the evaluation of my service related disability was originally rated low at 0%, and upon an immediate appeal was increased to 10% which I also feel was low considering the pain endured on a daily basis. Because of the chronic nature of the pain located in the lower L4-L5 region of the lumbar spine, I have had to endure drastic changes to my daily life since the date of my separation from service. I had enjoyed a very active life prior to my service related injury, however since my separation I have had to endure a more sedentary lifestyle and career choice. I have been unable to enjoy working out or running due to the constant pain in my lower back. I fear that over the years my back has progressively gotten worse and may one day require surgery to correct.” [sic]


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 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 his service-connected condition continues to burden him; but must emphasize that the Disability Evaluation System has neither the role nor the authority to compensate service 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 Veteran 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 :
20030725
Service IPEB – Dated 20030416
 VA - (2 Mos. Pre-Separation)
Condition
 Code Rating Condition Code Rating Exam
Low Back Pain, Mild to Moderate 5299-5295 0% Degenerative Disc Disease, Lumbar Spine 5293-5295 10% 20030606
No Additional MEB/PEB Entries
 Other x 1 20030606
Combined: 0%
 Combined: 10%


ANALYSIS SUMMARY:

Low Back Pain Condition. The CI twisted his back and developed immediate pain in the lower back after stepping into a hole while deployed in Afghanistan. The pain persisted through his deployment and post-deployment and was exacerbated by running. He was treated with PT including back rehabilitation class, pool, and traction therapy. A magnetic resonance image revealed degenerative joint disease (DJD) at L4-L5 with mild central disc protrusion without nerve impingement. Orthopedics diagnosed chronic LBP probably secondary to DJD L4-5. Medications and wearing of a corset brought some relief but the CI continued to have daily non radiating pain, from 2 of 10 up to 8 of 10 by the end of the day. There was no problem with bowel or bladder function or erectile function. The permanent profile identified the condition and documented the following limitations, no running, walking, or jumping, no airborne operations, alternate aerobic event with either biking or swimming, and no sit-ups for physical fitness testing. He was allowed to lift up to 50 pounds. The commander’s statement documented the profile limitations limited his ability to perform in his MOS.

At the MEB narrative summary, 7 months prior to separation, the CI reported the LBP was a 1 of 10 in intensity with a sedentary lifestyle but increased to 10 of 10 intensity, “right through the roof” if he tried to run. Prolonged sitting or standing exacerbated the pain. The MEB exam demonstrated no tenderness to palpation (TTP), no spasm, normal gait, normal heel/toe walk, limited extension with a pressure sensation at his low back, normal flexion, negative straight leg raise (SLR), no limb length discrepancy and normal neuromuscular findings of the lower extremities. At the VA Compensation and Pension exam, 2 months prior to separation, the CI reported constant pain at the lower back which radiated to the posterior aspect of each leg. The exam demonstrated a normal gait with increased pain at lower back with toe and heel walking. There was TTP of the lumbar vertebrae but there was no paraspinal muscle spasm and no lower extremity muscle atrophy. SLR was negative on the right and positive on the left at 45 degrees. ROM was within normal limits and while there was pain the ROM was not restricted by pain and there was no radiation of pain. There was also moderate pain in the lower back which continued to full range of all movements except flexion, extension, and right rotation where at full ROM, pain became severe. Sensory perception and DTRs were normal. Pain, weakness, lack of endurance and incoordination did not affect ROM. The X-rays were normal. The VA examiner diagnosed chronic lumbar strain.

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 0% rating coded 5295 (lumbosacral strain) for normal ROM without pain and is consistent the code criteria. The VA assigned a 10% rating coded 5293-5295 for a positive SLR on the left and pain with normal ROM. The Board notes that likely due to the waxing and waning nature of the medical condition the CI could likely have presented with or without painful motion which is noted in the VA and MEB, respectively. The Board carefully reviewed the service file for corroborating evidence in the 12-month period prior to separation and found evidence of painful motion while at an orthopedic exam. 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 as there is clinical evidence for disc disease and agreed the evidence did not support a higher rating than the 10% criteria. There is no evidence of ratable peripheral nerve impairment for additional rating. The Board notes there is a reasonable amount of evidence reflecting the inability to perform the duties of his MOS due to increasing pain IAW VASRD §4.40 (functional loss). The Board 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 10% as a fair permanent separation rating for the 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. In the matter of the LBP condition, the Board unanimously recommends a disability rating of 10%, 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 his prior medical separation:

UNFITTING CONDITION
 VASRD CODE
Lumbosacral strain 5293-5295 10%
COMBINED
 10%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20120707, 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 AR20130011076 (PD201201959)
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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