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AF | PDBR | CY2013 | PD 2013 01206
Original file (PD 2013 01206.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX         CASE: PD-2013-01206
BRANCH OF SERVICE: Army  BOARD DATE: 20140821
SEPARATION DATE: 20080604


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SGT/E-5 (13M/Multi Launch Rocket System) medically separated for degenerative disc disease (DDD) of the lumbar spine. The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty, but he could perform an alternate physical fitness test. He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB). The additional conditions charted below were listed on the Medical Board narrative summary (NARSUM) and found not unfitting by the PEB and, therefore, not rated. The back condition, characterized as “lumbar DDD,” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. No other conditions were submitted by the MEB. The Informal PEB adjudicated “DDD of the lumbar spine” as unfitting, rated 10%, citing criteria of the VA Schedule for Rating Disabilities (VASRD). The CI made no appeals and was medically separated.


CI CONTENTION: “I was given a rating of 10% for one issue instead of all issues. VA rated me 20% for same issue then reevaluated me at 70% without including my positive TBI. I cannot find meaningful employment due to my injuries.”


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 back condition is addressed below; and, as well as the contended, hypertension, hyperlipidemia, patellofemoral pain syndrome (PFPS), coronary artery disease (CAD) and paroxysmal atrial tachycardia (PAT) which are within the DoDI 6040.44 defined purview of the Board. The contended posttraumatic stress disorder is not 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.


 RATING COMPARISON :

Service IPEB – Dated 20080403
 VA - (2 Mos. Pre-Separation)
Condition
 Code Rating Condition Code Rating Exam
DDD of Lumbar Spine 5242 10% DDD, Prior Kyphoscoliosis … 5237 10% 20080425
Hypertension Not Unfitting Not Service Connected
Hyperlipidemia Not Unfitting Not Rated
PFPS Not Unfitting PFPS Left 5014-5260 10% 20080425
PFPS Right 5014-5260 0% 20080425
CAD Not Unfitting Not Rated
PAT Not Unfitting Atrial Tachycardia 7010 0% 20080425
Other x 5 (In Scope)
 Other x 2
Combined: 10%
 Combined: 20%
Derived from VA Rating Decision (VA RD ) dated 20081010 ( most proximate to date of separation [ DOS ] ).

ANALYSIS SUMMARY:

Lumbar Spine Condition. The service treatment record indicated the CI initially reported back pain in 1995 when he fell from an 18–wheeled armored vehicle when in Alaska. He separated in 1996 and entered the Reserves. He was awarded a 10% disability rating by the VA on 25 May 2001 for kyphoscoliosis of the thoracic and lumbar spine using code 5237. An X-ray performed on 20 February 2002 documented a slight scoliosis and compression deformity (compression fracture) at T8 and T9. He reenlisted in 2004 and had intermittent back pain. He was able deploy in 2006, but had aggravation of his back pain with body armor and other equipment. He was taken off patrol duty, but was able to complete the deployment. A magnetic resonance imaging (MRI) on 8 March 2004 showed slight DDD at L1-2, but was otherwise unremarkable. Intermittent treatment included profiles with duty modifications, medications, a back class, physical therapy, aquatic therapy, chiropractic treatment, acupuncture, steroid injections and the use of a TENS (electrical stimulation) unit. His pain was aggravated by prolonged standing or walking. Plain X-rays in 2005 were normal other than a slight left rotoscoliosis (rotation of the spine on its axis) seen in one set of X-rays. A repeat MRI on 11 January 2007 showed the previously noted DDD at L1-2 and mild degenerative bony changes. He was evaluated in orthopedics on 19 December 2007. He was noted the have normal, but painful, range-of-motion (ROM) of the lumbosacral back. The gait, stance and neurological examination were all normal. He was issued a P3 profile and referred for MEB. Spasm was absent. A permanent L3 profile was issued on 18 December 2007 for low back pain with restrictions of military functional activities. At the MEB exam dated 11 February 2008, the CI reported DDD, mild scoliosis, muscle spasms and arthritis in the spine. The MEB physical exam noted no tenderness to palpation, no spasms, no guarding and no limitation of movement. However, pain was elicited by flexion, extension and lateral flexion (of the spine). The MEB NARSUM dated 5 March 2008 noted the above history and that the CI was unable to meet duty requirements secondary to ongoing back pain despite treatment. The CI had a normal gait, lower extremity strength bilaterally and reflexes. Tenderness of the spine and paraspinal muscles was present. The commander’s statement was undated, but indicated the CI was not able to meet duty standards secondary to his back condition. No other condition was cited. At the VA Compensation and Pension (C&P) examination performed on 25 April 2008, 6 weeks prior to separation, the CI reported he first injured his mid lower back in 1994 when he fell from a truck and landed on his back on the ice. He did use a back brace and was able to walk 2 miles, although he had fallen multiple times and had difficulty standing or lifting heavy equipment. No incapacitating episodes were reported. On examination, his posture and gait were normal. Spasm was not recorded. The ROM was essentially normal (below), although painful, as was the motor examination. The ROM evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.

Thoracolumbar ROM
(Degrees)		 PT ~ 4.5 Mo. Pre-Sep MEB/PT ~ 3 Mo. Pre-Sep VA C&P ~2 Mo. Post-Sep
Flexion (90 Normal) 75 90 90
Combined (240) 190 225 235
Comment Spasm was noted with rotational movement, but it did not cause an abnormal gait or contour Pain on motion Posture and gait normal, pain with flexion 45⁰-90⁰, pain at the end of extension,
§4.71a Rating 10% 10%

The Board directs attention to its rating recommendation based on the above evidence. The Informal PEB assigned a 10% rating using code 5242 (Degenerative arthritis). The VA likewise continued a 10% rating, originally granted in 2001, using code 5237 (Lumbosacral strain). The limitation in motion and painful motion support a 10% rating. Absent incapacitation or spasm with an abnormal gait or contour, the Board found no route to a rating higher than the 10% adjudicated by both the PEB and VA. 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 for the lumbar spine condition.

Contended PEB Conditions. The Board’s main charge is to assess the fairness of the PEB’s determination that hypertension, hyperlipidemia, PFPS, CAD and PAT were not unfitting. None were referred by the MEB, but these were listed in the NARSUM and determined to meet retention criteria. 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.

Hypertension. The CI was on two antihypertensive medications with a blood pressure reading the MEB examination of 135/84 while his blood pressure readings at the VA C&P examination were between 124/75 and 127/86 (standing), which were in the normal range.

Hyperlipidemia. The CI was on medication and laboratory results were within normal limits on 8 January 2007. The Board observed that this is a laboratory finding and not ratable.

Patellofemoral Pain Syndrome. The CI was seen intermittently for knee pain, but there is no record of any evaluation for the knee after 2005 until the CI was in the MEB process. The VA C&P examination of the knee showed flexion of 0 to 120 degrees limited by body habitus and extension was 0 degrees with pain at the end on the left. Tests of meniscal status and instability of the knee were normal with no limitation of motion on repetition and no weakness or tenderness.

Coronary Artery Disease. The CI reported a history of a myocardial infarction (heart attack) in August of 2004. However, there is no record in evidence which documents that this actually was the case. He did have an abnormal electrocardiogram (EKG) as well as a chest wall abnormality (pectus excavatum which could change the position of the heart and, consequently, the EKG.) A full cardiac evaluation with extensive testing of the structure and function of the heart including coronary artery blood flow showed no ischemia (insufficient blood supply) or prior evidence of infarction (heart muscle damage).

Paroxysmal Atrial Tachycardia. The CI developed a rapid heartbeat in 2004 and was treated medically and was the heartbeat was well controlled. He did not have a pacemaker. The VA examiner indicated that the CI reported episodes of tachycardia (rapid heartbeat) about once a month for approximately 10 minutes, which eased with medication; the CI’s pulse rate was 72 and regular; and there was no testing documentation to confirm the frequency or permanency of the rapid heartbeat.

The hypertension, hyperlipidemia, PFPS, CAD and PAT were not profiled or implicated in the commander’s statement. None were judged to fail retention standards. Only the knee condition had ever been profiled and it, a temporary profile, lapsed almost 3 years prior to separation. All were reviewed by the action officer and considered by the Board. There was no performance based evidence 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 so no additional disability ratings are 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 spine condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication. In the matter of the contended hypertension, hyperlipidemia, PFPS, CAD and PAT 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 re-characterization of the CI’s disability and separation determination.


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20130826, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record






                          
XXXXXXXXXXXXXXXXXX
President
Physical Disability Board of Review


SAMR-RB                                                                         


MEMORANDUM FOR Commander, US Army Physical Disability Agency
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557


 SUBJECT: Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXXXXX, AR20140020441 (PD201301206)

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                                                  XXXXXXXXXXXXXXXXXX
                                                      Deputy Assistant Secretary of the Army
                                                      (Review Boards)
                                                     
CF:
( ) DoD PDBR
( ) DVA

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