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AF | PDBR | CY2013 | PD-2013-02041
Original file (PD-2013-02041.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXX  CASE: PD-2013-02041
BRANCH OF SERVICE: Army          BOARD DATE: 20140911
SEPARATION DATE: 20050429


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated National Guard SSG/E-6 (51N/ Construction Supervisor) medically separated for a back problem. The back condition 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 L3 profile and referred for a Medical Evaluation Board (MEB). The back condition, characterized as “chronic lumbar spine pain associated with lumbar disk bulging; chronic left leg pain with tremor and chronic sciatica,” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. The MEB also identified and forwarded three other conditions as medically acceptable. The Informal PEB combined the three related back conditions and adjudicated them “chronic subjective back pain, with radiation to left leg without neurologic abnormality” as unfitting, rated at 10% with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD). The CI made no appeals and per his request was transferred to the Retired Reserve.


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 those conditions identified but not determined to be unfitting by the PEB when specifically requested by the CI. The rating for the unfitting back condition to include the left leg pain and chronic sciatica is addressed below; 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 20050303
 VA - (STR)
Condition
 Code Rating Condition Code Rating Exam
Chronic Subjective Back Pain, W/Radiation to Left Leg w/o Neurologic Abnormality 5299-5237 10% DJD and DDD Lumbar Spine 5242-5243 10% STR
Left Leg Condition w/Tremor 5299-5262 0% STR
Other x 3 (Not in Scope)
 Other x 2 STR
Combined: 10%
 Combined: 10#%
Derived from VA Rating Decision (VA RD ) dated 200 60104 (most proximate to date of separation )


ANALYSIS SUMMARY:

Chronic Subjective Back Pain with Radiation to Left Leg. The service treatment record (STR) indicated the CI initial injury occurred on 13 September 2003 while deployed to Iraq sustained an injury when he fell from both a truck and a ladder, landing awkwardly on his feet; experience pain in his left leg two days later. Over the next few months, the CI condition was treated conservative such as medications (narcotic), physical therapy and epidural steroid injections with some relief of his symptoms. A diagnostic magnetic resonance imaging (MRI) dated 
31 January 2004 showed degenerative disc disease (DDD) and electro-diagnostic studies obtained in February 2004 were normal. The CI’s MEB range-of-motion (ROM) dated 
20 April 2004 showed flexion greater than normal 90 degrees and a combined ROM of 215 (25 degrees less than normal 240 degrees).

X-rays images of the lower back (lumbosacral spine) taken on 17 August 2004 were normal as were the images taken of sacroiliac joints that were obtained on 16 September 2004. The chiropractic treatment afforded some improvement, however, the CI continued to experience pain in the left leg especially with flexion and extension; there was no reports of incapacitation in the STRs. The CI was issued a permanent L3 profile dated 30 August 2004 for low back pain (LBP) without radiculopathy (nerve root origin resulting in pain, weakness, numbness or muscle dysfunction) and chronic left leg pain. The commander’s statement dated 2 September 2004 only commented “physical impairments” further details were omitted.

At the MEB examination dated 7 September 2004, the CI reported that he had LBP with numbness and tingling down the left leg. During an evaluation dated 21 September 2004, the examiner noted that the CI stated that he had a complained of LBP and sciatica for a duration of 2 years; however, no specific findings were recorded in the CI’s STRs. The MEB narrative summary (NARSUM) dated 11 January 2005; the CI reported that his pain was a 7 to 8 out of 10 (10 being the worst pain). The MEB examiner observed that the CI’s strength was excellent; reflexes were slightly decreased bilaterally; no sensory defects were present; there was no atrophy and the heel-toe walk was recorded as “good,” implying a normal gait. The CI’s ROM obtained on 8 February 2005 (2 months prior to separation) the CI’s had a reduced flexion of 75 degrees (normal 90 degrees) and a combined ROM of 145 degrees (normal 240 degrees). The reason for the decrease is not apparent from the record. Pain to the left leg was also documented.

The Board directed attention to its rating recommendation based on the above evidence. The PEB assigned a 10% rating using code 5299-5237 (lumbosacral strain) for chronic subjective back pain, with radiation to left leg without neurologic abnormality and with a thoracolumbar ROM limited by pain. By doing so the PEB combined and bundled the conditions of chronic lumbar spine pain associated with lumbar disk bulging, chronic left leg pain with chronic sciatica and tremor. The VA awarded a 10% rating using code 5242-5243 (degenerative arthritis-intervertebral disc syndrome) for degenerative joint and disc disease, lumbar spine. In the absence of incapacitating episodes or documented spasm altering gait or spinal contour, the Board finds no additional route to a higher rating for the chronic back pain condition. 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 back pain condition.

Chronic Sciatica (Chronic Left Leg Pain with Tremor). The Board then considered if a separately unfitting neuropathy existed at separation. It noted that the MEB determined that chronic left leg pain and chronic sciatica were separate medically unacceptable conditions, but that the PEB combined both with the “subjective back pain” into a single unfitting condition. As noted, electrodiagnostic testing was accomplished twice, in February and September of 2004 and normal both times without evidence of a peripheral neuropathy or a radiculopathy. A brain MRI and metabolic testing to evaluate the tremor were both normal. A neurological examination by a neurologist on 16 September 2004 was normal other than the resting tremor. No etiology for the tremor was established. The Board observed that while the permanent L3 physical profile dated 30 August 2004 was for low back pain without radiculopathy and chronic left leg pain, a profile dated 11 February 2004 listed the CI’s condition as LBP with radiculopathy. The commander’s statement dated 2 September 2004 did not explicitly address either the left leg pain or sciatica, listing only “physical impairment”. The Board first considered if sciatica, having been de-coupled from the combined PEB adjudication, was separately unfitting. The neurological examinations were normal as were both electrodiagnostic studies. The CI did report radiating pain, but this is subsumed under the back pain which has already been determined to be unfitting. After due deliberation, the Board concluded that the evidence did not support the presence of a separately unfitting condition at separation. Accordingly, it cannot recommend a separate disability rating for it.

The Board then considered the tremor, a neurologic condition, which was not addressed by the PEB. However, it was linked with chronic left leg pain by the MEB. The Board observed that the PEB did describe the CI’s disability as chronic subjective back pain, with radiation to the left leg without neurologic abnormality. As noted previously, no etiology for the tremor was established. The final two neurology notes in the record from 5 October and 16 September 2004 both released the CI without limitations. It was not mentioned on the final profile or the preceding profile, the only two in evidence. The Board found no evidence in the records available for review that the tremor was related to the back condition and therefore, it remains outside the scope of the Board. It was noted though, that it did not significantly interfere with duty performance and the evidence does not support that the tremor was a separately unfitting condition. The Board determined that no additional unfitting condition was present at separation.


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 Subjective Back Pain w/Radiation to Left Leg 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 recharacterization of the CI’s disability and separation determination.


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20131031, 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, AR20150003242 (PD201302041)

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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