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AF | PDBR | CY2013 | PD-2013-02000
Original file (PD-2013-02000.rtf) Auto-classification: Approved
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX         CASE: PD-2013-02000
BRANCH OF SERVICE: Army  BOARD DATE: 20140620
SEPARATION DATE: 20050622


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active Reserve CW2 (152H/Attack Pilot) medically separated for chronic back pain. 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 CI’s condition, characterized as “chronic mechanical low back pain” by the MEB, was forwarded to the Physical Evaluation Board (PEB) as not meeting retention standards IAW AR 40-501. No other conditions were submitted by the MEB. The PEB adjudicated “chronic back pain, with degenerative disc disease, without neurologic abnormality” as unfitting, rated 10%. The CI made no appeals and was medically separated.


CI CONTENTION: “The applicant wants all MEB/PEB conditions considered for being unfit for duty and rated.”


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 chronic back pain is addressed below; and, no 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 for Correction of Military Records.


 RATING COMPARISON :

Service IPEB – Dated 20050404
 VA - (~5 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Chronic Back Pain, with DDD, without Neurologic Abnormality 5299-5242 10% Herniated Disc at L4-L5, And L5-S1l 5003-5242 40% 20051208
Other x 0 (Not in Scope)
 Other x 7 20051208
Combined: 10%
 Combined: 50%
Derived from VA Rating Decision (VA RD ) dated 200 60804 ( most proximate to date of separation [ DOS ] ).


ANALYSIS SUMMARY:

Chronic Back Pain. The narrative summary (NARSUM), prepared 4 months prior to separation, noted the CI had onset of low back pain (LBP) in 1991 without significant duty limitations. LBP recurred in March 2004 with carrying luggage for 1/4 mile and increased symptoms led to interference with duty. Treatment included physical therapy (PT), chiropractic, orthopedic evaluation and medications of muscle relaxants and anti-inflammatories. Symptoms progressed and he was not a surgical candidate. LBP was noted as a recurring problem with radiation of pain and feeling of numbness and tingling down the legs (parasthesias-especially on the left). Pain did interfere with sleep. Symptoms were worse with prolonged sitting/standing over 20 minutes, and bending or lifting. There were no symptoms of bowel or bladder loss of control. Imaging (magnetic resonance imaging [MRI]) documented lumbar spine degenerative disk disease (DDD) and herniated disks (HNP at L5-S1 and L4-L5) with touching of the S1 and L5 nerve roots. Exams summarized below documented pain-limited range-of-motion (ROM) of the lumbar spine and an intermittent sensory deficit of the left foot. The DD Form 2808, Report of Medical Examination, dated 21 January 2005 noted tenderness with no spasm, painful decreased forward flexion and no motor, reflex or sensory loss. Straight leg raise testing increased the leg pain. A NARSUM Annex dated 30 March 2005 (3 months prior to separation) documented bilateral lower extremities with no deficit in strength, reflexes, or sensory testing. There was no muscle atrophy and heel/toe walk was without any weakness or imbalance.

At the VA Compensation and Pension exam performed 5 months after separation, the CI reported increased radiating pain and numbness in his legs with radiating pain causing his legs to feel weak. He had difficulty sleeping (awakened by pain) and flare-ups of severe pain at least 3 times a month. He was on medication and wore a back support that provided some help and was working at an Army Fleet Support. Imaging (CT) confirmed the findings of the MRI and electrophysiological study showed no evidence of radiculopathy.

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.

Thoracolumbar ROM
(Degrees)		 Chiropractic ~ 10 Mo. Pre-Sep
(20040803)		 PT ~9 Mo. Pre-Sep
(20040909)
 MEB ~4 Mo. Pre-Sep
(20050222)
 VA C&P ~5 Mo. Post-Sep
(20051208)
Flexion (90 Normal) 60 50 (90) 95, 96, 97 30
Extension (30) 25 15 (25) 25, 27, 27 15
R Lat Flexion (30) 30 Not measured (30) 30, 32, 31 15
L Lat Flexion (30) 25 (25) 25, 24, 23 15
R Rotation (30) 30 (30) 43, 42, 43 15
L Rotation (30) 20 (30) 44, 45, 43 15
Combined (240) 190 230 105
Comment: Spine formula Notes 2 (limit to normal) and 4 (rounding) applied Painful motion; tender; leg pain with straight leg raise (L); sensory and reflexes normal Normal gait, strength and coordination; sensory deficit to pinprick bottom of R foot: + R Patrick’s Pain limited; + tenderness; leg pain with straight leg raise; gait and motor normal Gait normal/slow; Severe limit due to pain & guarding; difficulty rising from a forward flexed position; motor/reflexes/sensory without deficit
§4.71a Rating 20% 20% 10% 40%

The Board directs attention to its rating recommendation based on the above evidence. Pain, whether or not it radiates, stiffness, or aching in the area of the spine is rated within the VASRD general rating formula for diseases and injuries of the spine IAW §4.71a. There were no documented periods of incapacitation for rating under the formula for rating intervertebral disc syndrome based on incapacitating episodes since 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. There was no evidence of a fixed motor or sensory loss (radiculopathy). The single exam documenting decreased pinprick sensation to the bottom of the right foot was followed by exams documenting no sensory deficit. The Board adjudged that there was insufficient evidence of a radiculopathy that rose to the level of being unfitting at the time of separation.

The critical rating consideration in this case is therefore the ROM limitations and which exam(s) best indicated the CI’s disability picture at the time of separation. The Board considered that the MEB exam, although closest to the date of separation, did not align with the more severe disability picture and limited ROMs noted in the service treatment record through multiple treatment episodes. The PT and chiropractic exams, coupled with the continued limited motion noted on the DD Form 2808 closer to separation, provided reasonable doubt of greater ROM limitation than that documented at the NARSUM. However, the VA exam was considered post-separation worsening and not indicative of the disability picture at separation. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board majority recommends a disability rating of 20% for the 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 back pain with DDD condition and IAW VASRD §4.71a, the Board majority recommends a disability rating of 20%, coded 5299-5242 IAW VASRD §4.71a. There were no other conditions within the Board’s scope of review for consideration.


RECOMMENDATION: T he 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 Back Pain, with DDD, without Neurologic Abnormality 5299-5242 20%
COMBINED 20%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20131003, 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 XXXXXXXXXXXXXXXXX, AR20150001816 (PD201302000)
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                                                  XXXXXXXXXXXXXXXXX
                                                      Deputy Assistant Secretary of the Army
                                                      (Review Boards)

CF:
( ) DoD PDBR
( ) DVA

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