Search Decisions

Decision Text

AF | PDBR | CY2013 | PD-2013-01641
Original file (PD-2013-01641.rtf) Auto-classification: Approved
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXX    CASE: PD-2013-01641
BRANCH OF SERVICE: Army  BOARD DATE: 20150206
SEPARATION DATE: 20040521


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated National Guard E-5 (Tank Mechanic) medically separated for chronic low back and knee pain. The conditions 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 P3/L3 profile and referred for a Medical Evaluation Board (MEB). The low back and knee conditions characterized as “low back pain” and “patellafemoral syndrome of the right knee” were forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. The MEB also identified one other condition, (cerebral aneurysm and aneurysm coiling) for PEB adjudication. The Informal PEB adjudicated “chronic Low back pain and chronic right knee pain” as unfitting, rated 10% and 0% respectively, with likely application of the Veterans Affairs Schedule for Rating disabilities (VASRD). The cerebral aneurysm and aneurysm coiling condition was found to be not unfitting. The CI made no appeals and was medically separated.


CI CONTENTION: “Still have same problems also VA never looks at my old Army Records under service# C-----”


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.










 RATING COMPARISON :

IPEB – Dated 20040329
 VA - (12 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Chronic Low Back Pain 5237 10% Degenerative Disc Disease, Lumbar Spine NSC* 20050511
Chronic Right Knee Pain 5099-5003 0% Osteoarthritis NSC 20050511
Cerebral Aneurysm… Not Unfitting No VA Rating
Other x0
 Other x2
Combined: 10%
 Combined: - %
Derived from VA Rating Decision (VA RD ) dated 200 50511 (most proximate to date of separation [ DOS ] )
*Not Service Connected (NSC)


ANALYSIS SUMMARY:

Chronic Low Back Pain. The service treatment records (STR) present for review reflects that the CI had a long history of LBP. The narrative summary (NARSUM) prepared 3 months prior to separation noted that the CI “injured back getting off of a tank” but was able to continue his military duties despite the pain. His pain was constant 3/10 intensity and did not require narcotic medication. He denied radiation of the pain, numbness or tingling and the pain was increased by prolonged standing and ruck marching. The CI stated that at the time of the NARSUM he could not perform his MOS related duties due to his inability to lift over 20 pounds. The NARSUM documented that plain film X-rays of the spine revealed mild degenerative disc disease at multiple levels with normal thoracic spine X-rays. The pertinent physical exam findings are summarized in the chart below. The VARD dated 12 months after separation documented that a VA Compensation and Pension (C&P) exam was performed 3 months prior to separation. The VARD documented that “[The CI] reported the onset of back pain in 1971, after Vietnam” and that X-rays showed significant anterior degenerative and mild posterior changes at L5-S1.

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) VA C&P ~3 Mos. P re -Sep MEB ~3 Mos. Pre-Sep
Flexion (90 Normal) 60 26
Combined (240) 175 -
Comment Normal gait & posture; Pos. painful motion & spasm; Normal reflexes, strength and sensation Lumbosacral spine ROM (Not thoracolumbar)
§4.71a Rating 20% (VA = Not Service Connected ) - (PEB 10%)

The Board directed attention to its rating recommendation based on the above evidence. The PEB adjudicated the chronic LBP condition by applying VASRD code 5237 (lumbosacral or cervical strain) and rated it 10% based on “flexion limited by pain alone.” The VA did not grant service-connection for the LBP condition. As the PEB adjudicated that the chronic LBP condition was unfitting and compensable, the Board, IAW DODI 6040.44, will apply VASRD rating standards for its recommendation. At the time of separation, the General Rating Formula for Diseases and Injuries of the Spine was in effect and relied on thoracolumbar ROM measurements for basing the level of disability. The Board reviewed the ROM documented on the NARSUM and found that it referenced lumbosacral ROM measurements that were used in the VARSD standards in effect 8 months prior to separation. Therefore, the Board placed the highest probative value on the C&P exam that documented thoracolumbar ROM measurements, which were consistent with a 20% rating under the spine’s rating formula. 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 chronic LBP condition.

Chronic Right Knee Pain. The NARSUM noted a 5-year history of gradual onset right knee pain without any specific injury. The CI stated that he could not stand for more than an hour because of the knee pain. He denied and locking or instability. The CI did not feel that the knee pain alone would be incapacitating for his work as a tank mechanic. The NARSUM documented that plain film X-rays of the right knee were within normal limits. The goniometric 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.

Right Knee ROM (Degrees) VA C&P ~3 Mos. Post-Sep MEB ~3Mos. Pre-Sep
Flexion (140 Normal) “Full” 135
Extension (0 Normal) “Full” 0
Comment Pos. painful motion & crepitus; No instability No effusion, instability, crepitus or tenderness
§4.71a Rating Not Service Connected 0% (PEB 0%)

The Board directed attention to its rating recommendation based on the above evidence. The PEB adjudicated the right knee condition applying by the analogous VASRD code 5099-5003, (degenerative arthritis), and rated it 0% based on full ROM, no joint instability. The VA did not grant service-connection for the right knee condition. As the PEB adjudicated that the chronic right knee pain condition was unfitting and compensable, the Board, IAW DODI 6040.44, will apply VASRD rating standards for its recommendation. The Board reviewed both exams present for review to arrive at its rating recommendation. Both exams documented non-compensable ROM measurements for the right knee and other abnormalities that would allow for application of any knee specific VASRD code. The NARSUM was 2 weeks more proximate to separation than the C&P exam. Board members placed primary consideration on its charge to “…reassess the accuracy and fairness of the combined disability ratings…” and to “…recommend that the Military Departments correct discrepancies and errors in such ratings.” Based on the right knee exam documented by the NARSUM exam, the PEB’s adjudication of a 0% disability rating was accurate and fair; therefore, no discrepancy or error needs to be corrected. 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 right knee pain condition.

Contended Cerebral Aneurysm and Aneurysm Coiling Condition. The Board’s main charge is to assess the fairness of the PEB’s determination that the cerebral aneurysm and aneurysm coiling condition was not unfitting. The Board’s threshold for countering fitness determinations is higher than the VASRD §4.3 (reasonable doubt) standard used for its rating recommendations, remains adherent to the DoDI 6040.44 “fair and equitable” standard, and requires a preponderance of evidence. The cerebral aneurysm and aneurysm coiling was profiled, implicated in the commander’s statement, and was judged to have existed prior to service by the MEB. The PEB adjudicated it to be not unfitting. The neurology NARSUM is the only clinical documentation related to the aneurysm present for review by the Board. The aneurysm was found “incidentally” and was “asymptomatic.” After the preventive “coiling” procedure, the CI had daily headaches that increased with physical activity (and likely to subside with symptomatic treatment according to the neurologist) and there were no significant neurologic findings on examination. All related information was reviewed by the action officer and considered by the Board. 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 cerebral aneurysm and aneurysm coiling and so no additional disability rating is 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 chronic LBP condition, the Board unanimously recommends a disability rating of 20%, coded 5237 IAW VASRD §4.71a. In the matter of the chronic right knee pain condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication. In the matter of the contended cerebral aneurysm and aneurysm coiling condition, the Board unanimously recommends no change from the PEB determination as 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 his prior medical separation:

UNFITTING CONDITION VASRD CODE RATING
Chronic Low Back Pain 5237 20%
Chronic Right Knee Pain 5099-5003 0%
Cerebral Aneurysm and Aneurysm Coiling Not Unfitting
COMBINED 20%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20130921, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record






XXXXXXXXXXXXXXX
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 XXXXXXXXXXXXXXX, AR20150009925 (PD201301641)


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                       XXXXXXXXXXXXXXX
                           Deputy Assistant Secretary of the Army
                           (Review Boards)

CF:
( ) DoD PDBR
( ) DVA

Similar Decisions

  • AF | PDBR | CY2013 | PD-2013-01895

    Original file (PD-2013-01895.rtf) Auto-classification: Denied

    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. Post-Separation)ConditionCodeRatingConditionCodeRatingExam Chronic Bilateral Knee Pain5099-500310%Retropatellar Pain Syndrome with Chondromalacia, Right Knee5099-501410%20040802Retropatellar Pain Syndrome with...

  • AF | PDBR | CY2009 | PD2009-00168

    Original file (PD2009-00168.docx) Auto-classification: Denied

    The medical basis for the separation was left shoulder and both knees arthritis and chronic low back pain (LBP). Service ( PEB )VA ~ 2 mos PEB ConditionCode Left shoulder and bi lateral knee pain due to degenerative arthritis, permanently service aggravate by injury. Both the military and VA exams concur that there was no painful motion of the right knee and if rated, the knee would support a 0% rating.

  • AF | PDBR | CY2012 | PD2012 01689

    Original file (PD2012 01689.rtf) Auto-classification: Approved

    The back and bilateral knee conditions, characterized as “chronic non-radicular low back pain”and“chronic bilateral knee pain”were forwarded as not meeting retention standards, to the Physical Evaluation Board (PEB) IAW AR 40-501.A symptomatic pes planus condition was identified by the MEB and also forwarded as failing retention standards.The informal PEB adjudicated the chronic low back and bilateral knee pain conditions as unfitting, rated 10% and 0%.The remaining condition was determined...

  • AF | PDBR | CY2014 | PD-2014-01014

    Original file (PD-2014-01014.rtf) Auto-classification: Denied

    The Informal PEB adjudicated “chronic low back pain”as unfitting, rated 10% citing application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).The remaining condition was determined to be not unfitting.The CI made no appeals and was medically separated. The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the VASRD standards to the unfitting medical condition at the time of separation....

  • AF | PDBR | CY2014 | PD-2014-00747

    Original file (PD-2014-00747.rtf) Auto-classification: Denied

    The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of theVeterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation. The VA rated the condition analogously to code 5242 at 10%, citing the range-of-motion (ROM) measurements done at the C&P examination.The limitation of motion at the MEB examination supported the 20% rating adjudicated...

  • AF | PDBR | CY2013 | PD2013 00793

    Original file (PD2013 00793.rtf) Auto-classification: Approved

    I request the review board consider: 1) the appropriate application of the VASRD rating for VA code 5237 based on the forward flexion of thoracolumbar spine documented in the NARSUM, 2) the rating of radicular pain as contributing to the unfitting condition in accordance with AR 635-40, Section 4-19f (6) (b), and 3) review all conditions identified but determined not to be unfitting by the PEB (see page 7 of NARSUM).” There is no evidence of a separately ratable functional impairment (with...

  • AF | PDBR | CY2014 | PD-2014-01673

    Original file (PD-2014-01673.rtf) Auto-classification: Approved

    SEPARATION DATE: 20061219 The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of theVASRD standards to the unfitting medical condition at the time of separation. Neck Pain and Headaches Condition .

  • AF | PDBR | CY2012 | PD 2012 00887

    Original file (PD 2012 00887.txt) Auto-classification: Approved

    Post-Separation) – All Effective Date 20060409 Condition Code Rating Condition Code Rating Exam Chronic LBP 5299-5242 0% DDD Lumbosacral Spine 5243 40% 20070122 Chronic Bilateral Knee Pain 5099-5003 0% S/P Arthroscopic Repair of Medial Meniscal Tear Right Knee w/ Traumatic DJD 5260-5010 10% 20070124 Left Knee Injury 5260 NSC* 20070122 No Additional MEB/PEB Entries Other x 13 20070122 Combined: 0% Combined: 70% Derived from VA Rating Decision 20070308 (most proximate from the date of...

  • AF | PDBR | CY2013 | PD-2013-02402

    Original file (PD-2013-02402.rtf) Auto-classification: Denied

    ANALYSIS SUMMARY :The Board acknowledges the impairment with which the CI’s service-connected condition continues to burden her but notes the Disability Evaluation System has neither the role nor the authority to compensate members for anticipated future severity or potential complications of conditions resulting in medical separation. RECOMMENDATION : The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination. Service...

  • AF | PDBR | CY2012 | PD2012-00783

    Original file (PD2012-00783.pdf) Auto-classification: Denied

    RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW BRANCH OF SERVICE: ARMY SEPARATION DATE: 20030126 NAME: XXXXXXXXXXXXXX CASE NUMBER: PD1200783 BOARD DATE: 20130130 SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SFC/E-4 (13B10/Artillery), medically separated for mechanical low back pain (LBP) secondary to back strain. The commander’s statement noted that the CI’s condition left him “incapable of...