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AF | PDBR | CY2013 | PD-2013-02126
Original file (PD-2013-02126.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXX     CASE: PD - 201 3 - 0 2126
BRANCH OF SERVICE: Army   BOARD DATE: 201 5 0331
SEPARATION DATE: 200 50317


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Food Service Specialist) medically separa ted for low back pain. The condition could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty but was authorized to perform an alternate physical fitness test. She was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB). The “ chronic low back pain ” 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 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: “Condition has worsened over the years. I am currently on daily medications to relieve constant pain, inflammation; daily activities are limited, modified to cope. Many days are really unexplainable of how I’m affected physically & mentally.”


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 20041210
 VA*-(~2 Mos. Pre-Separation)
Condition
 Code Rating Condition Code Rating Exam
Chronic Back Pain… 5237 10% Mechanical Low Back Pain with Degenerative Facet Disease, Lumbar Sprain 5242 10% 20050107
Other x0
 Other x16
RATING: 10%
 RATING: 60%
* Derived from VA Rating Decision (VA RD ) dated 200 50401 (most proximate to date of separation [ DOS ] )


ANALYSIS SUMMARY: IAW DoDI 6040.44, the Board’s authority is limited to making recommendations on correcting disability determinations. The Board reviews medical records and other available evidence to assess the fairness of PEB rating determinations, using the VASRD standards, based on ratable severity at the time of separation.

Chronic Back Pain Condition. The evidence supports that the CI injured her lower back while in Basic Training. She completed training and was deployed to Afghanistan from December 200 to August 2003. While deployed, she sought care for her low back pain (LBP) that included non-steroidal anti-inflammatory medications (NSAIDs), muscle relaxers, and a steroid injection. After completing her deployment, her LBP persisted and she continued treatment at her state-side post that included chiropractic manipulation, NSAIDs, and duty restriction. She had plain film X-rays of her lumbar spine that were normal. She had a normal bone scan of the thoracolumbar spine and underwent magnetic resonance imaging that revealed “Mild degenerative facet disease at L3/L4 causing minimal bilateral neuroforaminal narrowing without evidence of significant nerve root impingement.” There was one complaint of radicular symptoms. Her LBP continued and she was entered into the Disability Evaluation System. The narrative summary prepared 5 months prior to separation noted the CI endured LBP for a few years, in spite of several treatment modalities to include physical therapy, medications, chiropractic care, and profiles for limited activities. Lifting, bending, running, climbing, and carrying heavy loads increase her back pain, while rest and limited duties provide respite. Physical exam revealed tenderness to palpation (TTP) of the lumbar spine muscles. There was normal range-of-motion (ROM), strength, sensation and reflexes. At the VA Compensation and Pension (C&P) exam performed 2 months prior to separation, the CI reported 2 years of constant 10/10 sharp, squeezing LBP and muscle spasms. She reported episode of incapacitation three times a year that could last 2 days.

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) NARSUM/Ortho ~ 11 Mo. Pre-Sep PT ~ 9 Mo. Pre-Sep VA C&P ~ 2 Mo. Pre -Sep
Flexion (90 Normal) “finger tips to knees” 90 80
Extension (30) “about 20 degrees ” 30 30
Combined (240) - 240 230
Comment Pos. TTP & painful motion; Neg. straight leg raise (SLR) ; Normal strength, sensation & reflexes No comments Pos. TTP & painful motion; No spasm; Neg. SLR; No Deluca criteria
§4.71a Rating 10% 0 % (PEB 10%) 10 % (VA 10%)

The Board directed attention to its rating recommendation based on the above evidence. The PEB applied VASRD code 5237 (Lumbosacral or cervical strain) and rated it 10% with likely application of the VASRD. The VA applied code 5242 (degenerative arthritis of the spine) and also rated it 10% citing criteria contained in the general rating formula for diseases and injuries of the spine. The Board agreed that the C&P exam was the most comprehensive exam and was performed most proximate to separation (only 2 months prior to separation), therefore, determined it to be the most probative exam to base its rating recommendation. The ROM measurements documented meet the 10% rating criteria under the general rating formula for diseases and injuries of the spine. There was no muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour as required for the next higher 20% rating. Additionally, there was no evidence of intervertebral disc syndrome that would allow for rating based on incapacitation episodes. Considering the totality of the evidence and mindful of VASRD §4.3 (reasonable doubt), members agreed Board consensus was that a disability rating of 10% for the chronic back pain 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 chronic back pain 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 20131027, 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, AR20150011174 (PD201302126)


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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