Search Decisions

Decision Text

AF | PDBR | CY2013 | PD-2013-02237
Original file (PD-2013-02237.rtf) Auto-classification: Approved
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXX    CASE: PD-2013-02237
BRANCH OF SERVICE: Army  BOARD DATE: 20140930
SEPARATION DATE: 20060126

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (27M10/MLRS Repairman) medically separated for a chronic low back pain (LBP) condition. The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty although the CI could perform an alternate physical fitness test. He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB). The LBP condition was the only condition forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. The Informal PEB adjudicated “chronic low back pain” as unfitting, rated at 0%, with likely application of the 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 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 20051215
 VA based on Service Treatment Records (STR)
Condition
 Code Rating Condition Code Rating Exam
Low Back Pain 5299-5237 0% DDD of the Lumbar Spine 5242 20% 20060509
Other X 0 (Not in Scope)
Other x 3
Combined: 0%
 Combined: 40%
Derived from VA Rating Decision (VA RD ) dated 200 60608 (most proximate to date of separation )


ANALYSIS SUMMARY: The VA examination for lumbosacral range-of-motion (ROM) measurements was not included in the VA Compensation and Pension (C&P) examination proximate to separation. There were ROM measurements for the cervical spine which the VA rater applied for the lumbosacral spine. These values were not only labeled as cervical spine values, but are the normal values for the cervical spine which are quite different than the normal values for the lumbosacral spine.

Chronic Low Back Pain (LBP) Condition. The service treatment records indicated the CI developed low back pain while doing sit-ups in basic training in August 1999 and worsened after performing sit-ups again. An evaluation performed on 4 October 1999, noted there was no pain radiation down his legs or any bowel or bladder changes. The gait was normal. Orthopedic and neurologic examinations were otherwise normal except for flexion which was at 75 degrees and tightness throughout his bilateral thoracic and lumbar paraspinal muscles.
A CT scan obtained on 2 November 1999 of the lumbosacral spine, which was interpreted as normal, demonstrated minimal bulging of the annulus (fibrous outer layer of a disc) at L4-L5. Treatment consisted of physical therapy, chiropractic care, analgesics, muscle relaxers and nonsteroidal anti-inflammatory without benefit. Nevertheless he continued performing his duties until 2004 when he noted pain in the right lower back which radiated down into his left foot when running. X-rays of the lumbosacral spine were normal. Neurosurgical evaluation noted the CI had a tingling sensation and numbness on the bottoms of both feet precipitated by running and relieved by sitting, stretching, medication and lying flat on the back. Surgery was not indicated. A pain management specialist indicated that the magnetic resonance imaging (MRI) findings of very small central disc protrusion at L5-S1 which did not compress the nerve root may have been one etiology of the CI’s symptoms. A permanent L2 profile was issued on 11 June 2002 and a permanent L3 profile was issued dated 16 November 2005 for chronic back pain with restrictions of functional military activities. The commander’s statement dated 19 September 2005 reviewed in some detail the CI’s treatment history and noted he had chronic lower back pain since 1999.

At the MEB examination dated 18 October 2005, the CI reported back pain over the course of 6 years that begin in September 1999 with occasional numbness or tingling when the back pain was high. He also noted “lower back [pain] prevented lifting and being able to bend [his] body into tight areas to repair equipment”. Pain was treated with non-steroidal anti-inflammatory medication. The MEB physical examination noted decreased and painful ROM of the thoracolumbar spine. The narrative summary (NARSUM) dated 8 November 2005, noted the CI injured his back while performing sit-ups during advanced individual training. The CI stated the pain in his back was present nearly every day. A general physical examination was normal except for pain on the ROM of the thoracolumbar spine and reduced rotation bilaterally. Forward flexion was normal at 90 degrees, but the combined ROM reduced to 220 degrees from the normal 240 degrees. A focused musculoskeletal and neurologic examination demonstrated lumbosacral pain on motion, particularly for active and passive extension. Other than an antalgic gait (limp), the neurologic examination was normal. No incapacitation was noted.

At the VA Compensation and Pension (C&P) examination, dated 9 May 2006, performed approximately 4 months after separation, the CI reported resting made the pain better and walking made it worse. Sometimes the pain affected his ability to urinate (he had difficulty with initiation, not incontinence) and sometimes his legs went “to sleep . . . while sitting . . .” After separation, he worked as an electric installer for private yachts which required bending and crawling. The back pain caused him “difficulty doing it.” He has done a physical therapy/home routine for many years, did not use a brace or cane and took non-steroidal anti-inflammatory medication and Tylenol for pain. Examination revealed the CI had well-developed muscle bulk and tone with normal muscle strength. The CI “stated that he was not able to squat because of pain”. When asked a second time, he did presumably begin to squat by holding the exam table and stated “I am not able to do this. I would be in pain for days.” The examiner listed measurements for the ROM for the cervical spine (since the neck was one of the CI’s sites of pain); however no ROM was listed for the lumbosacral spine. The CI’s gait was normal as was the neurological examination. No incapacitation was reported. X-rays of the lumbosacral spine dated 28 April 2006 were normal.

The Board directed attention to its rating recommendation based on the above evidence. The PEB assigned a 0% rating using code analogous code 5299-5237 (lumbosacral strain) and noted the CI’s physical examination was remarkable for pain with movement and a full ROM. The VA awarded the CI a 20% rating using code 5242 (degenerative arthritis) for degenerative disc disease of the lumbar spine based upon a forward flexion of 45 degrees, which was noted to be of the cervical spine according to the STR, but was considered to be of the thoracolumbar spine according to the VA rater.
As noted, the measurements are consistent with the cervical spine, but not the lower back which delimits the probative value. The PEB noted the CI’s physical examination was remarkable for pain with movement, but his ROM’s for flexion and extension measurements were not limited by pain. The VA examiner noted a normal gait. Both the painful motion and the combined limited motion noted by the MEB examiner support a 10% rating. Therefore, 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 LBP 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. 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 low back pain condition, the Board unanimously recommends a disability rating of 10%, coded 5099-5003 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 5099-5003 10%
COMBINED 10%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20131106, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record




                          
                  XXXXXXXXXXXXXXX
         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 XXXXXXXXXXXXXXX, AR20150007087 (PD201302237)


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              XXXXXXXXXXXXXXX
                  Deputy Assistant Secretary of the Army
                  (Review Boards)

CF:
( ) DoD PDBR
( ) DVA

Similar Decisions

  • AF | PDBR | CY2013 | PD-2013-01911

    Original file (PD-2013-01911.rtf) Auto-classification: Denied

    The VA rated under a peripheral nerve code 8520 (sciatic nerve) at 40% (moderately severe) citing pain and numbness to both extremities; in addition to lumbar disc protrusion for 10% under code 5242 (degenerative arthritis).Board members first agreed that sufficient evidence of painful motion was present to justify the rating of 10%, as well as the presence of localized tenderness not resulting in abnormal gait or spinal contour IAW §4.59 and §4.71a.Next, members acknowledged the ROM values...

  • AF | PDBR | CY2013 | PD-2013-01871

    Original file (PD-2013-01871.rtf) Auto-classification: Denied

    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 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. Post-Separation) ConditionCodeRatingConditionCodeRatingExam Chronic...

  • AF | PDBR | CY2014 | PD-2014-02132

    Original file (PD-2014-02132.rtf) Auto-classification: Denied

    RECORD OF PROCEEDINGSPHYSICAL DISABILITY BOARD OF REVIEWNAME: XXXXXXXXXXXXXXX CASE: PD-2014-02132BRANCH OF SERVICE: MARINE CORPSBOARD DATE: 20150107 SEPARATION DATE: 20021130 The low back condition, characterized as “mild lumbar degenerative disc disease” (DDD) and “low back pain,” was forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E; no other conditions were submitted by the MEB.The PEB adjudicated “low back pain”as unfitting, rated 10%.

  • AF | PDBR | CY2014 | PD-2014-02120

    Original file (PD-2014-02120.rtf) Auto-classification: Denied

    “Lumbago”was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.AnInformal PEB (IPEB) adjudicated chronic low back pain(LBP) without neurologic abnormality as unfitting, rated 0%. The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of theVeterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation. RECOMMENDATION : The...

  • AF | PDBR | CY2013 | PD-2013-01641

    Original file (PD-2013-01641.rtf) Auto-classification: Approved

    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 reviewed both exams present for review to arrive at its rating recommendation. BOARD FINDINGS : IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB...

  • AF | PDBR | CY2013 | PD-2013-02289

    Original file (PD-2013-02289.rtf) Auto-classification: Approved

    The MEB only referred “chronic neck pain” and “chronic low back pain” to the Physical Evaluation Board (PEB) IAW AR 40-501. The MEB physical examination noted decreased range-of-motion (ROM) of the cervical areas and tenderness with spine palpation.The narrative summary (NARSUM) dated 7 April 2004 noted the CI could not perform the duties of his MOS secondary to chronic low back and neck pain.A permanent profile U3/L3dated 12 May 2004 was issued for neck pain, CTS and a chronic lower back...

  • AF | PDBR | CY2013 | PD-2013-01781

    Original file (PD-2013-01781.rtf) Auto-classification: Approved

    RECOMMENDATION : The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of her prior medical separation: Physical Disability Board of Review 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.

  • AF | PDBR | CY2013 | PD-2013-01214

    Original file (PD-2013-01214.rtf) Auto-classification: Denied

    A physical therapy note, the next day 26 March 2004 found range-of-motion (ROM) of 75 degrees flexion and 30 degrees of extension. RECOMMENDATION : The Board recommends that the CI’s prior determination be modified as follows; and, that the discharge with severance pay be recharacterized to reflect permanent disability retirement, effective as of the date of his prior medical separation: Physical Disability Board of Review

  • AF | PDBR | CY2013 | PD-2013-02152

    Original file (PD-2013-02152.rtf) Auto-classification: Denied

    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. There is an addendum to the NARSUM dated 13 July 2004 (7 months prior to separation) which documents constant pain rated 3-10/10 with radicular symptoms “left greater than right” and “exacerbated by prolonged sitting and standing.” The exam documents a normal gait and...

  • AF | PDBR | CY2012 | PD2012 01278

    Original file (PD2012 01278.rtf) Auto-classification: Denied

    The PEB coded the back condition utilizing the 2002 VASRD rating rules as 5299-5295, analogous to lumbosacral strain and citing DoDI 1332.39 and AR 635-40.The VA rating of 40% was under the current VASRD §4.71a rating code of 5242 (degenerative arthritis of the spine) which was not in effect at the time of the CI’s date of separation.The spine specific VA examination (6 months after separation) demonstrated significantly worse symptoms and ROMs than the general VA exam (near separation) and...