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AF | PDBR | CY2013 | PD-2013-02308
Original file (PD-2013-02308.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX          CASE: PD - 201 3- 0 2308
BRANCH OF SERVICE: Army   BOARD DATE: 201 5 0331
Separation Date: 20050912


SUMMARY OF CASE : Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5( Optician ) medically separated for a back condition. The back could not be adequately rehabilitated to meet the physical requirements of his M ilitary Occupational Specialty but was authorized to perform an alternate phy sical fitness test . He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB). The “C hronic L ow B ack P ain (LBP) w ith L5-S1 Degenerative Disc Disease ( DDD ) with Herniated Nucleus Pulposus ( HNP ) , central, and bilateral radicular symptoms , ” was the only condition forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. The Informal PEB adjudicated “chronic LPB secondary to L5-S1 HN P w ithout neurologic deficit” as unfitting, rated 10%, with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD). The CI made no appeals and was medically separated.


CI CONTENTION : “Chronic lower back pain w/nerve pain, heat conditions.”


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 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 :
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IPEB – Dated 20050728
 VA* - (~9 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Chronic LBP Secondary to L5-S1 HNP without Neurologic Deficit 5243 10% Myofascitis and Chronic Lumbosacral Strain 5021-5237 10% 20060601
Bilateral Leg Condition… Radicular Pain 8520 NSC 20060601
Other x 0
 Other x 3
RATING: 10%
 RATING: 20%
*Derived from VA Rating Decision (VARD) dated 20061115 (most proximate to date of separation [ DOS ] )

ANALYSIS SUMMARY : IAW DoDI 6040.44, the Board’s authority is limited to making recommendations on correcting disability determinations. The Board reviews medical records and other available evidence to assess the fairness of PEB rating determinations, using the VASRD standards, based on ratable severity at the time of separation.

Chronic LBP Secondary to L5-S1 HNP without Neurologic Deficit Condition . The CI developed back pain, and acute back strain after performing physical training in early 2001 . A lumbosacral spine x -ray was normal. A lumbosacral spine magnetic resonance imaging ( MRI ) showed L4-5 and L5-S1 diffuse disc bulges. He was treated with non-ste roidal anti-inflammatory drugs , muscle relaxants, physical therapy ( PT) and restrictions. The lumbosacral spine MRI again showed L4-5 and L5-S1 diffuse disc bulges. He was able to run two miles in 15 minutes twice a week. He rated his pain at 4/10. There were physical exam findings of tenderness over L3 to S1 and his reflexes, motor and sensory exams were normal. An MRI showed a central protrusion of L5-S1 without stenosis or definite significant foraminal narrowing. The Family Practitioner noted that the CI reported LBP that radiated to the legs, worse on the left and radicular pain triggered by bending over. There were physical exam findings of soreness on lumbar spine palpation; painful motion. The Pain Management Specialist documented chronic sharp LBP that waxed and waned in severity with radiation down to the left side and exacerbated by any kind of prolonged sitting or standing. There were physical exam findings of bilateral paraspinal tenderness with normal motor, sensory and reflexes. In January 2005 , the CI was given the first epidural steroid injection (ESI) for chronic LBP. The Family Practitioner noted that the CI had a slow gait and discomfort sitting. The VA Neurosurgeon noted that the CI was in constant LBP and increased with prolonged standing or sitting with intermittent left lower extremity pain greater than right lower extremity pain and intermittent numbness and tingling in his toes of both feet. A discogram was performed (date unknown) that increased his pain. A lumbar spine MRI showed a small central disc at L5-S1 without stenosis. The CI was seen again by Pain Management and he underwent a second ESI . The electromyogram ( EMG ) and nerve condition study (NCV) were negative for radiculopathy or other peripheral neuropathy.

The MEB narrative summary exam approximately 5 months prior to separation documented that the CI continued to have persistent LBP with radiation into both legs; limited functional abilities; pain especially with walking up or down stairs or with any stress activities, and intermittent trembling and leg muscle spasms with weakness, especially after stress. The Pain Management noted more back pain and the CI underwent a third ESI on 21 July 2005 . The VA Compensation and Pension (C&P) exam 12 months after separation documented sharp stiffness weakness, aching cramping, burning sharp LBP with a chronic severity of 10/10 and discomfort that travelled to his legs. The pain w as precipitated by physical activity with ep isodes of exacerbation as often a s three times daily. The CI noted that he had been confined to bed for two days at least four times over the prior month. He further noted that he had been required to defer his work duty seven to ten times due to an n exacerbation of the LBP. The C&P examiner commented that, “He states his condition does not cause incapacitation.” He occasionally required a back brace for support when he was required to p articipate in activities that required prolonged standing. The VA C&P physical exam findings are summarized in the chart below.

There were two 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 :
invalid font number 31502



Thoracolumbar ROM (Degrees) MEB ~ 4. 5 Mo. Pre-Sep VA C&P ~ 8.5 Mo. Post-Sep
Flexion (90 Normal) 90 75
Combined (240) 190 220
Comment Pos. painful motion & tenderness; Neg. straight leg raise (SLR); No atrophy; Normal reflexes Normal g ait ; Pos. painful motion & tenderness; Pos. SLR bilaterally ; Normal strength, reflexes & sensation; Pos. Deluca criteria
§4.71a Rating 10% * (PEB 10%) 10% (VA 10%)
invalid font number 31502 *IAW VASRD §4.59, Painful motion invalid font number 31502

The Board direct ed attention to its rating recommendation based on the above evidence . The PEB coded the c hronic LBP s econdary to L5-S1 HNP without neurologic deficit condition 5243 ( Intervertebral Disc Syndrome ) and rated at 10%. The VA coded the myofascitis and chronic lumbosacral strain condition as 5021 ( Myositis ) with 5237 ( Lumbosacral or Cervical Strain ) and rated at 10%. 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 . ” The MEB examiner documented a combined total ROM of 190 degrees and tenderness in the mid lower lumbar spine and in both sacroiliac joints. The CI met the 10% rating criteria for “combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees” and “localized tenderness not resulting in abnormal gait or abnormal spinal contour . ” The C&P examiner stated that there was no incapacitation; therefore, the Board did not consider using incapacitating episodes to rate code 5243 as allowed by the VASRD. 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. The motor impairment was relatively minor in that the CI reported lower extremity weakness and cannot be linked to significant physical impairment. There was no motor weakness noted on any examination. The EMG and NCV testing was negative for radiculopathy or other peripheral neuropathy. Since no evidence of functional impairment exists in this case, the Board cannot support a recommendation for additional rating based on peripheral nerve impairment. After due deliberation, considering all of the evidence and mindful of VARD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change i n the PEB adjudication for the chronic LBP s econdary to L5-S1 HNP without neurologic deficit 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 LBP secondary to L5-S1 HNP without neurologic deficit 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 .


invalid font number 31502


The following documentary evidence was considered:
Exhibit A. DD Form 294, dated 20 131105 , w/atchs
Exhib it B. Service Treatment Record
Exhibit C. Department of Veterans Affairs Treatment Record


XXXXXXXXXXXXXXXXXXXX
President
Physical Disability Board of Review

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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 XXXXXXXXXXXXXXXXXXXXXX , AR20150012442 (PD201302308)

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                                                  XXXXXXXXXXXXXXXXXXX
                                                      Deputy Assistant Secretary of the Army
                                                      (Review Boards)
                                                     
CF:
( ) DoD PDBR
( ) DVA





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