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AF | PDBR | CY2013 | PD-2013-02230
Original file (PD-2013-02230.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX         CASE: PD-2013-02230
BRANCH OF SERVICE: Army  BOARD DATE: 20150127
SEPARATION DATE: 20050802


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Healthcare Specialist) medically separated for chronic low back pain (LBP). 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 profile and referred for a Medical Evaluation Board (MEB). The LBP condition, characterized as “degenerative disc disease at L4/5 and L5/S1,” 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 low back pain” as unfitting, rated 10%. The CI made no appeals and was medically separated.


CI CONTENTION: “Belief condition was worse than stated.”


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 Veterans Affairs Schedule for Rating Disabilities (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 :

Service IPEB – Dated 20050603
 VA - (10 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Chronic Low Back Pain 5299-5242 10% Degenerative Disc Disease, L4-L5, L5-S1; Low Back Strain 5243 20% 20060601
Other x 0 (Not in Scope)
 Other x 0
Combined: 10%
 Combined: 20%
Derived from VA Rating Decision (VA RD ) dated 20061018 ( most proximate to date of separation [ DOS ] ).





ANALYSIS SUMMARY:

Chronic Low Back Pain. The record indicated that the CI injured his lower back in 2002 and developed LBP that was not resolved with conservative treatment including physical therapy, manipulation, anti-inflammatory and narcotic medications. Magnetic resonance imaging of the back documented broad based disc bulges at L4/5 and L5/S1 with articular facet degeneration and mild bilateral neural foraminal narrowing (constriction of the nerve passageways in the spine) without frank disc herniation or central canal stenosis. He was not a surgical candidate. The narrative summary (NARSUM) dated 3 months prior to separation noted pain as marked and constant, with the record indicating episodes of radiating pain. The NARSUM exam documented normal gait and range-of-motion (ROM) testing was forward flexion of 70 degrees (normal 90 degrees) and combined 180 degrees (normal 240 degrees). There was painful motion and tenderness to palpation. Straight leg raise testing (SLR-for radicular signs) was negative. Motor, reflex and sensory exams were normal.

At the VA Compensation and Pension exam performed 10 months after separation, the CI reported a similar injury history and back pain without radiating symptoms. Exam documented normal gait and ROM was forward flexion of 50 degrees (normal 90 degrees) and combined 170 degrees (normal 240 degrees). There was painful motion without decrease on repetition. SLR testing was negative. There was no tenderness, spasm, abnormal contour, or any deficits in strength, reflexes or neurologic exam. Lumbar spine X-rays were unremarkable.

The Board directed attention to its rating recommendation based on the above evidence. The PEB rated the LBP at 10% coded analogously to code 5242 (degenerative arthritis of the spine) citing tenderness and ROM “limited by pain” which may have been an application of AR 635-40 (ROM ratings only with a mechanical basis for limited motion – not pain limited). The VA rated the low back condition at 20% coded 5243 (intervertebral disc syndrome), based on decreased forward flexion of 50 degrees (no greater than 60 degrees). Both ratings used the General Spine Rating Formula with the VA exam documenting more severe forward flexion limitations. There was no documentation of incapacitating episodes and no objective peripheral nerve deficits (non-pain radiculopathy). Pain (whether or not it radiates) is rated under the General Spine Formula. The Board majority considered that the NARSUM exam, which was closer to the DOS and more nearly depicted the disability picture in the remainder of the record, had the highest probative value for rating at the time of separation. There was insufficient evidence of muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour, or for greater ROM deficits to warrant a 20% or higher rating. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board majority concluded that there was insufficient cause to recommend a change in the PEB adjudication for the low back 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 AR 635-40 for rating the back condition may have been operant in this case and the condition was adjudicated independently of that instruction by the Board. In the matter of the low back condition and IAW VASRD §4.71a, the Board majority 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


                 
XXXXXXXXXXXXXXXXXX
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 XXXXXXXXXXXXXXXXXX AR20150008359 (PD201302230)


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, Unite d 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                                                 
         XXXXXXXXXXXXXXXXXX      
         Deputy Assistant
                  Secretary of the Army
                                             (Review Boards)
                                                     
CF:
( ) DoD PDBR
( ) DVA

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