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AF | PDBR | CY2013 | PD-2013-02125
Original file (PD-2013-02125.rtf) Auto-classification: Approved
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXX       CASE: PD-2013-02125
BRANCH OF SERVICE: Army  BOARD DATE: 20140826
SEPARATION DATE: 20050810


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (88M/Motor Transport Operator) medically separated for a back condition. The back 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 back condition, characterized as “low back pain (LBP) with L4-L5 herniated nucleus pulposus” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. No other conditions were submitted by the MEB. The Informal PEB adjudicated “chronic LBP” as unfitting, rated 0% with likely application of AR 635-40, B-29. The CI made no appeals and was medically separated.


CI CONTENTION: “Due to the fact that I was injured while serving in the Army while in Kuwait.”[sic]


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 LBP condition 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 20050707
 VA - (1 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Chronic Low Back Pain 5237 0% Low Back Stain 5237 10% 20050927
Other x 0 (Not in Scope)
 Other x 8
Rating: 0%
 Combined: 10%
Derived from VA Rating Decision (VA RD ) dated 200 51215 ( most proximate to date of separation [ DOS ] ).


ANALYSIS SUMMARY:

Chronic Low Back Pain Condition. The CI entered active duty (prior NG 2003-2004) on 25 April 2004. The first entry for back pain and blackouts is from 27 July 2004, 3 months later. He had a lumbar spine X-ray performed on 18 October 2004 for lower back pain, which found moderate L5/S1 disc narrowing and mild L4/5 disc narrowing. He deployed to Kuwait on 30 December 2004. He was seen on 3 January 2005 with a history of LBP for a year and provided information from his chiropractor to the examiner. He was referred to orthopedics for consultation. On 19 January 2005, while still deployed in Kuwait, he fell off the back of a truck and was unable to stand, complaining of left sided weakness and decreased sensation. He continued with post-traumatic LBP and weakness of the left ankle. Spine films and a computerized tomographic (CT) scan were negative for fractures. A magnetic resonance imaging completed on 23 January 2005 found herniated disks at the L4-L5 and L5-S1 levels. He was treated as an in-patient with narcotics and muscle relaxants. Air evacuation was recommended on 26 January 2005. He was evaluated at Landstuhl Regional Medical Center and surgery was recommended only as a last option. He was transferred back to his home base on 29 January 2005.

The narrative summary (NARSUM) on 9 June 2005, 2 months prior to separation, notes the CI reported occasional episodes of LBP without functional limitation prior to AD service in April 2004. He injured his back standing up quickly from a chair in July 2004 and October 2004. He sought medical attention and was well enough to deploy to Kuwait. While in Kuwait he fell off a truck, landing on his buttocks and had increased pain. Neurosurgical and orthopedic evaluations did not recommend surgery. He continued physical therapy and pain clinic management. The CI stated he had constant LBP 9/10. A 9 June 2005 physical examination performed by a different provider, but cited in the NARSUM, found tenderness from the cervical to the sacral spine and sacroiliac joints with minimal paralumbar muscle tenderness. There was a negative straight leg raise test for radiculopathy, deep tendon reflexes were present 1+ throughout, strength was 5/5 and sensation was intact. ROM cited from a physical therapy consultation was normal except for extension and is summarized in the chart below. The NARSUM clarified the extension ROM was by limited by pain.

The MEB orthopedic consultation on 4 May 2005, 3 months prior to separation, revealed a fairly normal walk with heel and toe walk without much difficulty. Reflexes were 2+ at the patellar tendons and 1+ at the Achilles. Sensation was intact. The straight leg raising test was negative and there was no point tenderness of the spine. Range-of-motion (ROM) of the back was limited by pain somewhat, however, when he came up to full extension, he had no back spasm.

The VA Compensation and Pension exam performed a month after separation noted normal gait, no bowel or bladder problems, normal extremities, normal motor strength and normal reflexes. Positive right and left straight leg raising test, pain with ROM was noted to begin at flexion of 70 degrees and hyperextension at zero degrees, without additional ROM loss upon repetitive use. ROM is summarized in the chart below.

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)
MEB ~ 3 Mo. Pre-Sep

VA C&P ~ 1 Mo. Post-Sep
Flexion (90 Normal) 90 65
Extension (30) 0 20
R Lat Flexion (30) 30 15
L Lat Flexion (30) 30 15
R Rotation (30) 30 15
L Rotation (30) 30 15
Combined (240) 210 145
Comment Extension limited by pain Flexion and Extension limited by pain
§4.71a Rating 10 % 10 %

The Board directs attention to its rating recommendation based on the above evidence. The Board considered VASRD diagnostic code 5237 (lumbosacral or cervical strain) which is rated under the General Rating Formula for Disease and Injuries of the Spine. Both the PEB and the VA used this code. The PEB rated at 0% and the VA rated at 10%. The CI met the 10% rating criteria of combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees by both MEB and VA examinations in evidence. The rating recommendation also considered VASRD §4.59 painful motion and §4.40 functional loss. The Board did not find evidence of a residual neurological impairment from the post injury left ankle weakness for a separate or alternate code. The radiating pain, stiffness, or aching in the area of the spine is subsumed under the general rating formula. There was no evidence of incapacitating episodes in the record, except after the acute injury in January 2005, for a higher rating using alternate coding. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the chronic low back pain 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. In the matter of the chronic LBP condition, the Board unanimously recommends a disability rating of 10%, coded 5237 IAW VASRD §4.71a. 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 Condition 5237 10%
RATING 10%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20131101, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record





                 
XXXXXXXXXXXX
President
Physical Disability Board of Review


 invalid font number 31502 SAMR-RB                                                                         


MEMORANDUM FOR Commander, US Army Physical Disability Agency
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557


 invalid font number 31502 SUBJECT: Department of Defense Physical Disability Board of Review Recommendation
invalid font number 31502 for XXXXXXXXXXXX, AR20150004767 (PD201302125)

 invalid font number 31502
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 10% 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                                                  XXXXXXXXXXXX
                                                      Deputy Assistant Secretary of the Army
                                                      (Review Boards)

CF:
( ) DoD PDBR
( ) DVA

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