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AF | PDBR | CY2013 | PD-2013-02206
Original file (PD-2013-02206.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXX  CASE: PD-2013-02206
BRANCH OF SERVICE: Army  BOARD DATE: 20140618
SEPARATION DATE: 20051018


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (25L10/Cable System Installation Maintenance Specialist) 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/H2 profile and referred for a Medical Evaluation Board (MEB). Degenerative disc disease (DDD), L-4-5, L5-S-1 vertebral level, 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 back pain” as unfitting, rated 10%, with likely application of service regulations and the VA Schedule for Rating Disabilities (VASRD). The CI made no appeals and was medically separated.


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 chronic back pain condition 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 20050908
 VA – (At Separation)
Condition
 Code Rating Condition Code Rating Exam
Chronic Back Pain, without Neurologic Abnormality 5299-5242 10% Lumbosacral Degenerative Disc Disease 5243 10% 20051025
No Other Item in Scope
 Other x 5 (Not in Scope)
Combined: 10%
 Combined: 10%
Derived from VA Rating Decision (VA RD ) dated 200 60130 ( most proximate to date of separation [ DOS ] ).


ANALYSIS SUMMARY:

Chronic Back Pain without Neurologic Abnormality Condition. The CI developed chronic low back pain (LBP) associated with radiation of discomfort into the legs after physical training in late 2003. Magnetic resonance imaging disclosed a herniated intervertebral disc at L4-5 and DDD at L4-5 and L5-S1. An orthopedic surgery evaluation concluded surgery was not advised. Spine injections in August 2004 and October 2004 resulted in resolution of radiating symptoms; however, LBP preventing strenuous military duties persisted. At the time of the MEB history and physical examination on 31 May 2005, the CI reported using Tylenol and a muscle relaxer when needed. On examination, there was tenderness and pain with motion. Gait was normal, and straight leg raising was negative for radiating symptoms. Lower extremity strength was normal (5/5) and reflexes were normal (2+). The MEB physical therapy range-of-motion (ROM) examination on 15 August 2005 recorded active thoracolumbar flexion of 70 degrees (normal 90), extension of 27 degrees (normal 30), left lateral flexion 28 degrees (normal 30), right lateral flexion 30 degrees (normal 30), left rotation 37 degrees (normal 30) and right rotation 48 degrees (normal 30), all with three repetitions. Pain with motion was reported. According to the VARD dated 30 January 2006, the CI underwent VA Compensation and Pension (C&P) examinations on 25 and 27 October 2005, a week after separation. At the spine examination, the CI reported continued LBP with occasional radiation into the legs and flare-ups with prolonged walking. On examination, there was full range but painful motion.

The Board directs attention to its rating recommendation based on the above evidence. The PEB rated the chronic back pain due to lumbar DDD without neurologic abnormality 10% (coded 5299-5242, degenerative arthritis of the spine) citing motion limited by pain and tenderness. The VA also rated the lumbosacral DDD 10% (coded 5243, intervertebral disc syndrome) citing the VA C&P examination from October 2005. The limitation of thoracolumbar ROM at the time of the MEB physical therapy examination supports the 10% rating adjudicated by the PEB and is in accordance with the VASRD general rating formula for diseases and injuries of the spine. There was no documentation of spasm causing altered gait or spinal contour at the time of MEB evaluation to support the next higher rating. The Board also considered rating the back condition using the VASRD formula based on incapacitating episodes due to intervertebral disc syndrome. The criteria are based on the number of incapacitating episodes in the prior 12 months requiring bed rest prescribed by a physician. No documented physician directed bed rest was evidenced in the service treatment records during the 12 months prior to separation. The Board concluded the evidence did not support a higher rating using this alternate formula and thus providing no additional benefit to the CI. The Board also considered if additional disability rating was justified for peripheral nerve impairment due to radiculopathy. The CI had a herniated disc with radicular pain treated with injections which were reported to improve the radiating pain. The MEB examination documented normal strength, reflexes, gait, and a negative provocative examination test for radicular signs. The presence of functional impairment with a direct impact on fitness is the key determinant in the Board’s decision to recommend any condition for rating as additionally unfitting. While the CI may have suffered additional pain from nerve involvement, this is subsumed under the general spine rating criteria, which specifically states “with or without symptoms such as pain (whether or not it radiates).” Therefore the critical decision is whether or not there was a significant motor weakness which would impact military occupation specific activities. There is no evidence in this case that motor weakness existed to any degree that could be described as functionally impairing. The Board therefore concludes that additional disability rating was not justified on this basis. 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.


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. As discussed above, PEB reliance on rating criteria for rating the low back condition was likely operant in this case and the condition was adjudicated independently of that policy/instruction by the Board. In the matter of the chronic back pain, without neurologic abnormality 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 20131101, 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, AR20150002588 (PD201302206)

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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