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AF | PDBR | CY2013 | PD-2013-02260
Original file (PD-2013-02260.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXX          CASE: PD -20 1 3 - 0 2260
BRANCH OF SERVICE: Army   BOARD DATE: 2014 1105
Separation Date: 20070621


SUMMARY OF CASE : Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SGT/E-5 (25S/SATCOM System Operator/Maintainer) medically separated for diskogenic low back pain. The back condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS) or satisfy physical fitness standards. He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB). Degenerative disc, status post micro discectomy at L5/S1 was forward to the Physical Evaluation Board (PEB) IAW AR 40-501. No other conditions were submitted by the MEB. The Informal PEB adjudicated “chronic diskogenic low back pain (LBP) status post micro discectomy” as unfitting, rated at 10%, with likely application of Veterans Affairs Schedule for Rating Disabilities (VASRD). The CI made no appeals and was medically separated.


CI CONTENTION : The CI listed “1. Additional ailments diagnosed that weren’t previously known to exist (traumatic brain injury); 2. VA combined rating is 70%; 3. Please consider all conditions granted as service connected disability towards my medical separation.”


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 ba ck condition is addressed below and there are no additional conditions within the DoDI 6040.44 defined purview of the Board. The requested traumatic brain injury (TBI) and other conditions service connected by the VA were not identified by the PEB, and thus are not 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 :
invalid font number 31502
Service IPEB – Dated 20070320
 VA - (1 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Chronic Diskogenic LBL S/P micro discectomy 5243 10% Chronic Low Back Strain, Herniated Nucleus Pulposus L5-S1 5243 10% 20070720
Radiculopathy, Right Lower Extremity 8599-8520 10% 20070720
Other x 0 (Not in Scope)
 Other x 1
Rating: 10%
 Combined: 20%
Derived from VA Rating Decision (VARD) dated 20071120 (most proximate to date of separation )

ANALYSIS SUMMARY : The Board makes note that some of the CI’s contended conditions are derived from VA’s evaluations performed well after separation and that his current VA ratings are higher than those reflected in the above rating chart. The Board’s operative instruction, DoDI 6040.44, specifies 12 months interval for special consideration to VA findings. This does not mean that the later VA evidence was disregarded, but the Board’s recommendations are directed to the severity and fitness implications of conditions at the time of separation. Therefore, the evidence from the service treatment record is assigned significantly more probative value as a basis for the Board’s recommendations.

 L ow B ack P ain Condition . There w as only one range-of- motion (ROM) evaluation in evidence, with documentation of additional ratable criteria, that the Board took into consideration in arriving at its rating recommendation , summarized in the chart below.

Thoracolumbar ROM (Degrees) MEB ~ 4.5 Mo. Pre-Sep VA C&P ~ 1 Mo. Post-Sep
Flexion (90 Normal) No ROM’s 80
Combined (240) 230
Comment Decreased sensation ; No muscle spasm; Normal gait, strength & reflexes Pos. painful motion ; No antalgic gait ; N o muscle spasm , tenderness or Deluca criteria
§4.71a Rating 10 % VA 10%

The CI in j ured his back during advanced individual training in December 2003. The CI was followed by physical therapy for LBP and radicular symptoms that radiated to the right lower extremity. A lumbar spine magnetic resonance imaging revealed a moderate extrusion of material at L5 - S1 with disc material compressing the exiting right S1 nerve root. The neur ologist noted that the CI reported having sharp, shooting, numbing, tingling and radiating pain at his midline low er lumbosacral site that spread to the right hip, radiated down into the right thigh than into his right foot . He also reported that activities increased the pain level and taking narcotic medication to relieve pain .

The physical exam ination findings were positive for st rai ght leg raise on the right and the nerve condition study was normal. The CI was evaluated by pain management in June 2004 ; the examiner noted that the CI had some muscle spasm s with severely limited lumbar flexion at 10 degrees, a maximum lumbar flexion of 20 degrees and a normal motor / sensory exam . The examiner diagnosed radicular leg pain secondary to disc extrusion and recommended the CI for epiduroscopy which was performed on 8 July 2004 . Pain management examiner later noted no improvement in CI’s symptoms therefore he was re ferred for a discography and underwent surgery for an L5-S1 herniated nucleus pulposus on 2 November 2004.

The MEB narrative summary (NARSUM) exam ination ( approximately 5 months prior to separation ), documented persistent decreased sensation to light touch and pain on the o utside aspect of the right foot S1 distribution. The examiner also noted that the CI had a normal gait, no muscle spasm and pain ratin g was recorded as moderate / intermittent IAW t he American M edical Association . The MEB ’s history and physical exam ination documented decreased ROM of the lumbar spine with tenderness to palpation and decreased sensation in the right lower extremity. The MEB NARSUM physical exam findings were summarized in the chart above.

The VA Compensation and Pension (C&P) exam ination ( performed a month post separation ) , documents that the CI ambulated with no signs of pain while reporting to and / or during his physical examination. The CI complained of constant and moderate LBP with unpredictable flares , lasting for approximately 20 minutes and relieved by rest ing . The flare-ups were usually associated with radiation of pain to his right leg accompanied with muscle spasm . The LBP are aggravate by prolong standing, sitting, lifting more than five pounds and / or any strenuous physical activity that required the use of his back. The VA C&P physical exam findings were summarized in the chart above.

Board precedent is that a functional impairment tied to fitness is required to support a recommendation for addition of a peripheral nerve rating at separation. The pain component of a radiculopathy is subsumed under the general spine rating as specified in §4.71a. The sensory component in this case has no functional implications. There was no m otor impairment documented and the nerve conduction study was normal. Since no evidence of functional impairment exists in this case, the Board cannot support a recommendation for additional rating based on peripheral nerve impairment.

The Board directs attenti on to its rating recommendation based on the above evidence . The PEB coded the chronic discogenic LBP status post micro dis c ectomy condition as 5243 (i ntervertebral disc syndrome ) , rated at 10%. For the chronic low back strain , herniated nucleus pulposus L5-S1 status post micro discectomy condition , the VA use code 5243 , rated at 10%. The Board did not find any evidence of incapacitation th at could be used to rate 5243 based on periods of incapacitation. The General Rating Formula for Diseases and Injuries of the Spine co nsiders the CI’s pain symptoms with or without symptoms such as pain and whether it radiates or not , stiffness or aching in the area of the spine affected by residuals of injury or disease . The Board considered the VA C&P exam ination to be the most probative exam based on it containing the required ROM measurements and being closest to separation. That exam documented ROM measurements , no muscle spasm or antalgic gait which are consistent with the 10% rating . 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 discogenic LBP condition without the addition of a peripheral neuropathy 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 chronic discogenic LBP status post micro dis c ectomy 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 20 131104 , w/at tachment s
Exhib it 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, AR20150002647 (PD201302260)


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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