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AF | PDBR | CY2013 | PD-2013-02073
Original file (PD-2013-02073.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXX    CASE: PD-2013-02073
BRANCH OF SERVICE: Army  BOARD DATE: 20150325
SEPARATION DATE: 20050614


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Combat Engineer) medically separated for chronic low back pain. The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty; however, his physical profile authorized him to perform an alternate aerobic physical fitness test event. He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB). The condition characterized as “chronic low back pain due to degenerative disc disease” 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: “I have several conditions that were not considered during my MEB. They rushed me out! I have migraines 30%, depression 50%,” (continued) “radiculopathy 10%, degenerative disc disease 10%, spinal stenosis (pending) and severe upper gastritis (pending). I feel that they tried to get rid of me as quickly as possible. The Army did not address any of my conditions. I was not given a medical screening for anything except my back. The doctor in charge told me I wasn’t there for other stuff. He said he was only concerned about my back.”


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 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 20050211
 VA* - (~2 Mos. Pre-Separation)
Condition
 Code Rating Condition Code Rating Exam
Chronic Low Back Pain… 5237 10% Degenerative Disc Disease, Lumbar Spine 5237 0% 20050406
Other x 0 (Not In Scope)
 Other x 3
RATING: 10%
 RATING: 0%
* Derived from VA Rating Decision (VA RD ) dated 20 050907 (most proximate to date of separation [ DOS ] ) .


ANALYSIS SUMMARY:

Chronic Low Back Pain Condition. The narrative summary and treatment record noted onset of low back pain (LBP) in 2003 following a parachute jump. He developed recurring LBP not responsive to conservative treatment including anti-inflammatory medications, physical therapy (PT) and chiropractic care. Imaging documented normal plain X-rays with magnetic resonance imaging findings of degenerative disc disease (DDD) and an L4-5 disc bulge. The CI was on narcotic pain medication and had back pain exacerbated by motion or activity. Exam noted a normal gait with pain limited motion, tenderness, and no weakness or sensory or reflex abnormalities. The goniometric range-of-motion (ROM) evaluation from PT documented pain limited motion with forward flexion of 80 degrees (normal 90) and combined 200 degrees (normal 240) from the lowest measured ROM as there was potential transposition of the recorded active and passive ROMs.

At the VA Compensation and Pension exam performed approximately 2 months prior to separation, the CI reported similar history of back pain onset with continued use of narcotic and non-narcotic pain medication and relaxants. He denied radiating pain. On exam gait and posture were normal. There was no motor, sensory, or reflex deficit. There was no tenderness, spasm, or pain with full motion to the VA normal ROM limits, or decrease following repetition. VA records and ratings remote from separation indicated a 10% rating for the low back condition effective in June 2005, addition of a 10% left leg radiculopathy rating in 2010. No imaging was performed as the CI missed his radiology appointment. The diagnosis was “No pathology is identified on physical exam to render a diagnosis.” The VA rated this exam at 0%; however, subsequent VARD from November 2006 indicated award of a 10% for the back condition, effective in June 2005. There was no accompanying narrative in that VARD, aside from indications of a prior Notice of Disagreement (appeal). Remote VA evidence indicated a 20% DDD rating effective in 2008 and addition or a Left leg radiculopathy in 2010.

The Board directed attention to its rating recommendation based on the above evidence. Proximate to separation the back exams predominately documented painful motion, with formal MEB testing noting pain limited motion. Remote VA increased ratings were adjudged as after separation worsening and not indicative of the CI’s disability condition at the time of separation. There were indications of low back tenderness, painful motion, and rare spasm without changes in gait or spinal contour that supported the 10% rating level (IAW VASRD §4.59 painful motion and §4.71a. No exams documented limited ROM to the 20% rating level (forward flexion 60 degrees or less; or combined ROM 120 degrees or less). There were no documented periods of physician prescribed bed rest for any higher rating under the formula for intervertebral disc syndrome, and no evidence of peripheral nerve deficits (leg weakness or other radicular symptoms interfering with duty) for additional rating based on residuals. Considering the totality of the evidence and mindful of VASRD §4.3 (reasonable doubt), members agreed that a disability rating of 10% for the LBP condition was appropriately recommended in this case.

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 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 20131030, 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, AR20150011175 (PD201302073)


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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