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AF | PDBR | CY2013 | PD-2013-02281
Original file (PD-2013-02281.rtf) Auto-classification: Approved
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXX  CASE: PD -20 13 - 0 2281
BRANCH OF SERVICE: Army   BOARD DATE: 2014 102 4
Separation Date: 20050410


SUMMARY OF CASE : Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (31R/Military Policeman) medically separated for chronic back pain. The 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). The chronic low back pain (LBP) condition, characterized as “not meeting retention standards” was forwarded to the Physical Evaluat ion Board (PEB) IAW AR 40-501 . No other conditions were submitted by the MEB. The I nformal PEB adjudicated “chronic back pain” as unfitting, rated 10% with likely application of the VA Schedule for Rating Disabilities (VASRD). The CI made no appeals and was medically separated.


CI CONTENTION : “Lower back pai n caused by compressed disk.”


 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; 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 20041221
 VA - (At Separation)
Condition
 Code Rating Condition Code Rating Exam
Chronic Back Pain 5237 10% Degenerative Disc Disease (DDD), Lumbar Spine 5237 10% VARD*
No Additional MEB/PEB Condition
 Other x1
Combined: 10%
 Combined: 10%
* VARD dated 20050418 based the rating on evidence found in the evidence & VA C&P dated 20010117 which was not available for review


ANALYSIS SUMMARY : IAW DoDI 6040.44, the Board’s authority is limited to making recommendations on correcting disability determinations. The Board’s role is thus confined to the review of medical records and all evidence at hand to assess the fairness of PEB rating determinations, compared to VASRD standards, based on ratable severity at the time of separation.

Chronic Back Pain Condition . There w ere range - of - motion (ROM) evaluations in evidence, with documentation of additional ratable criteria, which the Board weighed in arriving at its rating recommendation; as summarized below :

Thoracolumbar ROM (Degrees)
 MEB 5.5 Mo s . Pre-Sep PT 5 Mo s . Pre-Sep VA C&P 3 Mo s . Post-Sep
Flexion (90 Normal)
 No ROMs noted 55 “Full ROM without restriction”
Combined (240)
 180
Comment
 Mild tenderness to palpation; No muscle spasm; Neg. straight leg raise (SLR); Pos. painful motion; Normal motor/reflexes/sensory P os. painful motion No muscle spasm; Normal curvature; No painful motion; No atrophy; Neg. SLR bilaterally
§4.71a Rating
 10 % 20 % 10 %
invalid font number 31502
The CI developed LBP in 2001 during Advanced Individual Training when he was assisting with mov ing beds and lockers to a new barracks. He was seen twice in s ick c all for back pain and was given a non-st eroidal anti-inflammatory drug , a muscle relaxant and was issued a temporary profile. The thoracic spi ne X -ray showed mild scoliosis centered approximately at the T3 vertebral body apex to the right. Lumbar spine X -rays perfomed on both 9 December 2002 and 10 May 2004 were both normal . In January 2003 he was diagnosed with mechanical LBP and sent to p hysical t herapy (PT). The PT recommended b ack classes for upper back strengthening and several ultrasound treatments and use of a transcutaneous electrical nerve stimulation (TENS) unit . He was seen intermittently by a c hiropractor throughout 2004 who continued to note lower back tenderness, occasional shooting pain that radiated to the left hip, buttocks to the knee and diagnosed lumbago. The CI was given a permanent L3 p rofile for back pain. The lumbar spine MRI showed small annular bulges at all levels without spinal stenosis or a h erniated disc. The o rthopedist noted recurrent LBP that interfered with sleep and exam findings of full ROM, normal reflexes, sensation a nd motor strength. The c ommander’s s tatement documented that the CI had functional limitations of an inability to run over one mile, an inability to lift over 25 pounds, no prolonged standing over 45 minutes and an inability to construct a fighting position. He was unable to perform the duties of his MOS. The MEB n arrative s ummary (NARSUM) exam approximately 5.5 months prior to separation documented constant mild LBP. The MEB NARSUM physical exam findings were summarized in the chart above. The CI was seen by PT for MEB NARSUM ROM measurements approximately 5 months prior to separation . The PT physical exam findings were also summarized in the chart above . The VA Compensation and Pension (C&P) exam was missing from evidence. The VARD dated 18   April 2005 indicated that the VA C&P exam dated 17 January 2005 showed all normal ROM without muscle spasm, muscle atrophy in the back, buttocks or lower extremities and a negative straight leg raise on both sides.

The Board directs attenti on to its rating recommendation based on the above evidence . The PEB coded the c hronic b ack p ain condition as 5237 l umbosacral or cervical strain and rated at 10%. The VA used the same coding for the DDD , l umbar s pine with t horacolumbar s coliosis condition and rated at 10%. The 18 April 2005 VARD assigned a 10% rating based on the evidence found in the service treatment record and a C&P examination dated 17 January 2005 . The Board considered the 10% rating criteria – “Localized tenderness not resulting in abnormal gait or abnormal spinal contour” versus the 20% rating criteria “Forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees. ” The PT exam which was done for the MEB NARSUM had three separate and complete ROM measurements. The forward flexion as indicated by a measurement of 55 degrees . The “General Rating Formula for Diseases and Injuries of the Spine considers the CI’s pain symptoms “with or without symptoms such as pain (whether or not it radiates), stiffness or aching in the area of the spine affected by residuals of injury or disease . ” After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 20 % for the c hronic b ack p ain 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 c hronic b ack p ain condition, the Board unanimously recommends a disability rating of 20 %, coded 5237 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 Back Pain
5237 2 0%
COMBINED
 2 0%
invalid font number 31502

The following documentary evidence was considered:
Exhibit A. DD Form 294, dated 20 131109 , w/atchs
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, AR20150007083 (PD201302281)


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 20% 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                                                  XXXXXXXXXXXXXXXXX
                                                      Deputy Assistant Secretary of the Army
                                                      (Review Boards)

CF:
( ) DoD PDBR
( ) DVA

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