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AF | PDBR | CY2013 | PD-2013-01947
Original file (PD-2013-01947.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXX   CASE: PD-2013-01947
BRANCH OF SERVICE: Army         BOARD DATE: 20150206
SEPARATION DATE: 20050328


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty 0-2 (Transportation Officer) medically separated for a back problem. The back condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty. He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB). Mechanical low back pain (LBP), secondary to intervertebral disc degeneration, characterized as medically unacceptable, was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. No other condition was submitted by the MEB. The Informal PEB adjudicated chronic low back pain as unfitting, rated 10%, with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD). The CI made no appeals and was medically separated.


CI CONTENTION: The CI elaborated no specific contention in his application.


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 :

Service IPEB – Dated 20041222
 VA* - (~5 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Chronic Low Back Pain 5243 10% Lumbosacral DDD 5243 10% 20050811
Other x 0 (Not in Scope)
 Other x 1
Combined: 10%
 Combined: 10%
*Derived from VA Rating Decision (VARD) dated 20050929 (most proximate to date of separation (DOS))





ANALYSIS SUMMARY:

Chronic Low Back Pain. Treatment records evidence that the CI presented on 24 November 2002 with a 3-day history of LBP. He reported that he had prior episodes of back pain. The physical examination revealed mid-lumbar tenderness to palpation, a positive straight leg raise (positive nerve involvement), and muscle spasms. He was diagnosed with mechanical LBP. Treatment included antiinflammatory and muscle relaxant medications and a course of physical therapy. A neurologic consultation note dated 3 January 2003 documents three episodes of acute LBP with an antalgic gait. A magnetic resonance imaging (MRI) study dated 24 January 2003 revealed early degenerative disc disease (DDD) at the lumbosacral junction, severe spinal canal stenosis, and (partial spina bifida) incomplete formation of the bones around the spine at the upper sacral level (S1-2). A MRI dated 8 March 2004 noted DDD at the L4-5 and L5-1 levels with disc bulging at L4-5 and L3-4. Despite conservative management, the CI continued to report LBP was radiation down both legs. At the narrative summary examination dated 15 November 2004, approximately 4 months prior to separation, the CI reported persistent LBP with “periodical” radicular pain and mild paresthesias. The examiner noted that the CI was treated with epidural steroid injections with minimal pain relief and was determined not to be a surgical candidate by neurosurgery. The physical examination was significant for tenderness of the paravertebral lumbar muscles, mild midline tenderness, and decreased thoracolumbar range-of-motion (ROM) (flexion 70 degrees; extension 20). There was no evidence of spasms, kyphosis, lumbar lordosis, or scoliosis. A diagnosis of mechanical LBP secondary to intervertebral disc degeneration was rendered.

At the VA Compensation and Pension examination dated 11 August 2005, approximately 5 months after separation, the CI reported constant LBP and a history of radicular pain. The physical examination was significant for decreased thoracolumbar ROM (flexion 70 degrees; extension 20) without additional limitation with repetitive motion, pain, fatigue, weakness, or lack of endurance.

The Board directed attention to its rating recommendation based on the above evidence. The PEB adjudicated the chronic LBP as unfitting. The PEB and VA rated the LBP at 10%; coded 5243 (intervertebral disc disease). The Board considered whether there was evidence to support a higher the 10% for the LBP condition. VASRD code 5243 can be rated “either under the General Rating Formula for Diseases and Injuries of the Spine or under the Formula for Rating Intervertebral Disc Syndrome based on incapacitating episodes, whichever method results in the higher evaluation when all disabilities are combined under §4.25.” The VASRD defines an incapacitating episode as “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.” Although the CI underwent multiple treatment modalities for LBP, there was no evidence of incapacitating episodes (requiring physician prescribed bed rest) and one documented 24 hours quarters. There was no evidence of forward flexion of the thoracolumbar spine greater than 30 degrees, but not greater than 60 degrees; or, a combined ROM of the thoracolumbar spine not greater than 120 degrees for a 20% rating under the general rating formula for the spine. 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 chronic 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. 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 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 20131029, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record







XXXXXXXXXXXXXXX
President
DoD Physical Disability Board of Review
AMR-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, AR20150010567 (PD201301947)


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

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