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AF | PDBR | CY2013 | PD-2013-01434
Original file (PD-2013-01434.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXX  CASE: PD-2013-01434
BRANCH OF SERVICE: Army  BOARD DATE: 20141028
SEPARATION DATE: 20040923


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an Army Reserve, SGT/E-5 (88H20/Cargo Specialist) on a temporary tour of active duty who was medically separated for low back pain (LBP). 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). The low back condition, characterized as “Herniated L4-5 disc and L5-S1 Annular tear” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. The MEB also identified and forwarded three other conditions as not disqualifying: hypercholesterolemia, hypertension, and migraines for PEB adjudication. The PEB adjudicated “chronic low back pain with lumbar pain on flexion/extension and rotation” as unfitting and it rated 10%. The remaining conditions were determined to be not unfitting. The CI made no appeals and was medically separated.


CI CONTENTION: “I believe my rating should be changed because my discharge from active duty was related to the work I performed prior to my discharge. I was discharged because I was told that I was no longer any use to being in the Army because of my back problems that I suffered with due to my duties while serving in the military.”


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 low back pain condition is addressed below; additional conditions are 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 of Correction of Military Service.


 RATING COMPARISON :

Service IPEB – Dated 20040527
 VA* - (2 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Chronic Low Back Pain 5237 10% Intervertebral Disc Syndrome with Degenerative Changes Lumbar Spine 5243-5237 10% 20041130
Other x3 (Not in Scope)
 Other x16(Not in Scope)
Combined: 10%
 Combined: 20%
Derived from VA Rating Decision (VA RD ) dated 200 50418 (most proximate to date of separation [ DOS ] )
*This VARD represents a request to reopen the previous claim and review a new condition; original VARD dated 20040924 was not available for review


ANALYSIS SUMMARY: IAW DoDI 6040.44, the Board’s authority is limited to making recommendations on correcting disability determinations. The Board’s role is thus confined to the review of medical records and all evidence at hand to assess the fairness of PEB rating determinations, compared to VA Schedule for Rating Disabilities (VASRD) standards, based on ratable severity at the time of separation.

Chronic Low Back Pain Condition. The CI had a long history of chronic LBP before 1987. During a deployment to Iraq in 2003, he experienced an acute exacerbation of his back pain when he landed wrong while playing basketball. He experienced the onset of right sided radicular pain after that injury. His pain continued and several months later he was medically evacuated out of the theater to his state-side base for further evaluation and treatment. A magnetic resonance imaging study in December 2003, revealed a herniated disc at L4-5 and an annular tear of disc L5-S1. In spite of an evaluation by an orthopedic surgeon who advised medical treatment, duty restriction and physical therapy, his back pain with right sided radicular symptoms continued and the CI was referred into the Disability Evaluation System. The narrative summary and the MEB exam were both dated the same day 5 months prior to separation and documented continued symptoms of LBP of 7-8/10 intensity daily with numbness/tingling into his right leg over an 8-month period. The pertinent physical exam findings are documented in the chart below. At the VA Compensation and Pension (C&P) exam performed 2 months after separation, the CI reported he had a ruptured disc since 1987. He described constant burning/aching pain at 8/10 intensity. It was relieved by the medication, Tramadol, Tylenol, Naproxen and Celebrex and required bed rest. He related incapacitating episodes as often as 4 times per year, which lasts for 5 days. Over the past year he had nine incidents of incapacitation for a total of 180 days. The pertinent physical exam findings are summarized in the chart below.

The goniometric range-of-motion (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)
 MEB/NARSUM ~6.5 Mo. Pre-Sep PT ~6 Mo. Pre-Sep VA C&P 2 Mo. Post-Sep
Flexion (90 Normal)
 - 80 70
Combined (240)
 - 195 185
Comment
 Pos. tenderness to palpation (TTP), painful motion & straight leg raise (SLR) bilat. ; Normal neuro. exam ; No atrophy -5 for extension = unable to achieve 0 degrees which is normal Normal gait & posture; Pos. painful motion; No muscle spasm or TTP ; Pos. SLR on right
§4.71a
 - 10% (PEB 10%) 10% (VA 10%)

The Board directs attention to its rating recommendation based on the above evidence. The PEB applied VASRD code 5237 (lumbosacral strain) and rated it 10% based on painful motion and tenderness. The VA applied a combination code of 5243, Intervertebral disc syndrome, with 5237 and also rated it 10% based on the ROM measurements documented in the C&P exam. While the VA applied the 5243 code, it used code 5237 for rating under the General Formula for Rating Diseases and Injuries of the Spine. The evidence documents that the CI did have an intervertebral disc syndrome that could be rated based on incapacitating episodes; however, the evidence did not contain any documented episodes of incapacitation that met the VASRD definition, “For purposes of evaluations under diagnostic code 5243, an incapacitating episode is a period of acute signs and symptoms due to intervertebral disc syndrome that requires bed rest prescribed by a physician and treatment by a physician.” The Board then considered that both exams proximate to separation documented ROM measurements consistent with the 10% rating IAW the General Formula for Rating Diseased and Injuries of the Spine. Considering the totality of the evidence and mindful of VASRD §4.3 (reasonable doubt), members agreed Board that a disability rating of 10% for the LBP condition was appropriately recommended in this case.


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 LBP condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication. 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 20130912, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record








                 
XXXXXXXXXXXXXXXXX
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 XXXXXXXXXXXXXXXXX , AR20150006456 (PD201301434)

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

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