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AF | PDBR | CY2013 | PD-2013-01569
Original file (PD-2013-01569.rtf) Auto-classification: Approved
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX         CASE: PD -20 1 3 - 0 1569
BRANCH OF SERVICE: Army   BOARD DATE: 2014 1217
Separation Date: 20050114


SUMMARY OF CASE : Data extracted from the available evidence of record reflects that this covered individual (CI) was a Reserve E-6 (Personnel Administrative Specialist) medically separated for a back condition. The back condition could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty. She was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB). The back condition, characterized as “chronic low back pain (LBP) secondary to an old herniated nucleus pulposus” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. The MEB also identified and forwarded one other medically acceptable condition (left great toe stiffness) for PEB adjudication. The Informal PEB was adjudicated as a non-duty related case under the provisions of DOD Directive 1332.18, para 3.5 and DoDI 1332.38, finding the chronic low back and foot pain unfitting. The CI appealed to the Formal PEB (FPEB). The FPEB determined the conditions were duty related and adjudicated “chronic radiating LBP” as unfitting, rated 0%. The left great toe was determined to be not unfitting and therefore not rated. The CI made no further appeals and was medically separated.


CI CONTENTION : “Feet/Back. Injury prevents me from doing many basic daily tasks .”


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 when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting. Any conditions outside the Board’s defined scope of review and any contention not requested in this application may remain eligible for future consideration by the Board for Correction of Military/Naval Records. Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate. The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation. The Board has neither the role nor the authority to compensate for post-separation progression or complications of service-connected conditions. That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws. The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.

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RATING COMPARISON :
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Service FPEB – Dated 20041103
 VA – 88 Months Post-Separation
Condition
 Code Rating Condition Code Rating Exam
Chronic Radiating LBP 5242 0% Chronic LBP 5237 NSC 20120529
Left Toe Stiffness Not Unfitting Bunionectomy Left Foot 5280 NSC 20120529
Other x0
 Other x 1 20120529
Rating: 0%
 Rating: NSC
Derived from VA Rating Decision (VARD) dated 20120628 (most proximate to date of separation [DOS])

ANALYSIS SUMMARY :
Chronic Radiating LBP Condition . The CI injured her back while doing pull-down exercises in 2002. She felt significant right - sided LBP with radiation into the posterior aspect of her thigh down to her knee. The lumbar spine magnetic resonance imaging showed multilevel degenerative disc disease with findings most pronounced at L4-5 with a left sided protrusion and prominent canal stenosis. The CI underwent extensive physical therapy (PT) including a Transcutaneous Electrical Nerve Stimulation ( TENS ) unit, ultrasound and pelvic traction for LBP with radiation to the left l eg . The n eurosurgeon documented the CI ’s progressive LBP with muscle spasm and left leg pain . The physical exam findings were minimal limited range-of-motion ( ROM ) ( less than 10 degree s ) , a slowed b ut steady gait, with normal mot or, sensory and reflexes. The n eurosurgeon diagnosed lumbar stenosis and lumbar spondylosis . The MEB n arrative s ummary (NARSUM) exam approximately 5 months prior to separation documented occasional LBP approximately one to two episodes per month. When the CI had these episodes, she treated herself symptomatically with non-steroidal anti-inflammatory medications and was able to continue her normal activities. A lumbar spine X -ray performed at the time of this exam showed slightly decreased joint space of the L5-S1 and L4-5 joint spaces and minimal osteophyte (bone spur) formation without any spondylolisthesis (slipped vertebra) . The examiner recommended the CI be retained with a P3 profile as she perfo rmed her primary job quite well and had 18 years of creditable service. The MEB NARSUM physical exam findings are summarized in the chart below . The MEB History and p hysical exam documented mild paravertebral muscle t e n der ness and painful ROM . The CI was evaluated by PT for ROM abilities in preparation for the MEB exam which are summarized below. The VA Compensation and Pension (C&P) exam (over 7 years after separation ) documented intermittent LBP once or twice a month that radiated from the mid back to the lower buttocks bilaterally and lasted three or four days. The VA C&P physical exam findings are summarized in the chart below .

There were two 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)
 NARSUM ~5 Mos. Pre-Sep PT ~3.5 Mos. Pre-Sep VA C&P > 7 Years Post-Sep
Flexion (90 Normal)
 “Without limitation” 55 70
Combined (240)
 - 190 190
Comment
 No tenderness to palpation; No painful motion; Normal motor, sensory & reflexes Goniometer used;
+ painful motion
No painful motion
§4.71a Rating
 0% 20% 10% (VA NSC)
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invalid font number 31502 The Board direct invalid font number 31502 ed invalid font number 31502 attention to its rating recommendation based on the above evidence. invalid font number 31502 The PEB coded the invalid font number 31502 c invalid font number 31502 hronic invalid font number 31502 r invalid font number 31502 adiating LBP invalid font number 31502 condition invalid font number 31502 5242 invalid font number 31502 ( invalid font number 31502 d invalid font number 31502 egenerative arthritis of the spine invalid font number 31502 ) invalid font number 31502 rated invalid font number 31502 0%. The VA coded the invalid font number 31502 c invalid font number 31502 hronic LBP condition 5237 invalid font number 31502 ( invalid font number 31502 l invalid font number 31502 umbosacral strain invalid font number 31502 ) invalid font number 31502 and invalid font number 31502 did not invalid font number 31502 s invalid font number 31502 ervice invalid font number 31502 - invalid font number 31502 connec invalid font number 31502 t invalid font number 31502 . invalid font number 31502 invalid font number 31502 The General Rating Formula for Diseases and Injuries of the Spine considers the CI’s pain symptoms “ invalid font number 31502 w invalid font number 31502 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.” invalid font number 31502 The Board considered the higher probative value proximity to separation of the MEB NARSUM at invalid font number 31502 5 invalid font number 31502 invalid font number 31502 months prior to separation and the invalid font number 31502 PT exam invalid font number 31502 at invalid font number 31502 4 invalid font number 31502 invalid font number 31502 months prior to separation invalid font number 31502 . invalid font number 31502 T invalid font number 31502 he invalid font number 31502 PT exam invalid font number 31502 contained complete ROM invalid font number 31502 measurements and was the exam most proximate to separation invalid font number 31502 . T invalid font number 31502 herefore, invalid font number 31502 Board members invalid font number 31502 agreed invalid font number 31502 the PT exam more accurately described the CI’s condition at the time of separation and had the highe invalid font number 31502 st invalid font number 31502 probative value. The invalid font number 31502 forward invalid font number 31502 flexion of 55 degrees met the 20% invalid font number 31502 rating invalid font number 31502 criteria “ f invalid font number 31502 orward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees invalid font number 31502 . invalid font number 31502 ” invalid font number 31502 invalid font number 31502 invalid font number 31502 After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 20% for the c invalid font number 31502 hronic invalid font number 31502 r invalid font number 31502 adiating LBP condition. invalid font number 31502

Contended PEB Conditions . The contended l eft great toe stiffness was adjudicated as not unfitting by the PEB . The Board’s first charge with respect to th is condition is an assessment of the appropriateness of the PEB’s fitness adjudication. The Board’s threshold for countering fitness determinations is higher than the VASRD §4.3 (reasonable doubt) standards used for its rating recommendations, but remains adherent to the DoDI 6040.44 “fair and equitable” standard and require a preponderance of evidence . The MEB examiner documented the CI had significant stiffness in her left toe which precluded vigorous activities such as push-ups which required hyper dorsiflexion of the great toe ; however , normal walking did not bother her , nor did her normal desk job. The MEB examiner did not physically examine the left great toe. The MEB examiner’s recommendations related only to the CI’s spinal condition ; there was no mention of the left toe. invalid font number 31502 This condition invalid font number 31502 was not profiled invalid font number 31502 invalid font number 31502 and invalid font number 31502 the invalid font number 31502 condition invalid font number 31502 was invalid font number 31502 not judged invalid font number 31502 to fail retention standards. invalid font number 31502 Th invalid font number 31502 e left invalid font number 31502 toe condition invalid font number 31502 was reviewed invalid font number 31502 and considered by the Board. There was no indication from the record that invalid font number 31502 this condition invalid font number 31502 significantly interfered with satisfactory duty performance. After due deliberation in consideration of the preponderance of the evidence, the Board concluded there was insufficient cause to recommend a change in the PEB fitness determination for the l eft t oe s tiffness and therefore, no additional disability rating 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. The Board did not surmise from the record or the F PEB ruling in this case that any prerogatives outside the VASRD were exercised. In the matter of the c hronic r adiating LBP condition, the Board unanimously recommends a disability rating of 20 %, coded 5242 IAW VASRD §4.71a. In the matter of the contended l eft great t oe s tiffness condition , the Board unanimously recommends no change from the PEB determination of not unfitting. 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 Radiating L ow B ack P ain 5242 2 0%
RATING
2 0%
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The following documentary evidence was considered:
Exhibit A. DD Form 294, dated 20 050114 , w/atchs
Exhib it B. Service Treatment Record
Exhibit C. Department of Veterans Affairs Treatment Record





                          
XXXXXXXXXXXXXXXXXX
President
 DoD 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, AR20150008339 (PD201301569)


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                                                  XXXXXXXXXXXXXXXXXX
                                                      Deputy Assistant Secretary of the Army
                                                      (Review Boards)

CF:
( ) DoD PDBR
( ) DVA

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