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AF | PDBR | CY2013 | PD-2013-02331
Original file (PD-2013-02331.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXX          CASE: PD-2013-02331
BRANCH OF SERVICE: ARMY           BOARD DATE: 20140814
SEPARATION DATE: 20081224


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SSG/E-6 (13B/Cannon Crewmember) medically separated for a chronic low back condition. The back condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty; however, he could do an alternate physical training test. He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB). The back condition, characterized “lumbar spondylolysis L4-5 and L5-S1” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. The MEB also identified and forwarded seven other conditions, all meeting retention standards, for PEB adjudication. The Informal PEB adjudicated the chronic low back condition as unfitting rated 20% IAW the VA Schedule for Rating Disabilities (VASRD). The remaining conditions were determined to be not unfitting. The CI made no appeals and was medically separated.


CI CONTENTION: “I was medically discharged for a condition in which I see other people getting medically retired and I need to know if I fit the bill to be retired. I served almost 19 years and feel I did my time to retire.”


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 low back condition is addressed below; no additional conditions are within the Board’s defined DoDI 6040.44 purview. 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 20081027
 VA - (Exam ~ 1 Mo. Pre-Separation)
Condition
 Code Rating Condition Code Rating Exam
Chronic Low Back Pain 5237 20% Degenerative Disc Disease of the Thoracolumbar Spine 5243 10% 20081114
Other X 7 (Note in Scope)
 Other x 12 20081114
Combined: 20%
 Combined: 30%
Derived from VA Rating Decision (VA RD ) dated 200 90310 (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’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 Low Back Condition. Review of the service treatment record showed that the CI experienced a history of low back discomfort that worsened while deployed to Iraq in 2007, but was not a consequence of injury. Lumbar spine X-rays showed disc narrowing, minimal osteophyte formation at L4-5 and possible minimal compression fractures at T12 and L1. A lumbar magnetic resonance imaging study showed degenerative discs with small disc herniations at L4 to S1 and foraminal narrowing at L5-S1. The CI failed nonsurgical management with activity modification, physical therapy, muscle relaxants, anti-inflammatory and narcotic pain medications, oral steroids and injections. Although specialized testing proved that disc disease at L4-5 and L5-S1 was the cause of his pain, the CI declined a surgical option because the likelihood of return to full unrestricted duty was very low.

At the narrative summary exam on 16 September 2008 (3 months prior to separation) the CI complained of baseline 6/10 (0-10 severity scale) low back pain (LBP) with associated numbness around the right hip and intermittent radiation down the anterior thigh. The pain increased to 10/10 severity with periodic flares and changes in activity. Pain was aggravated by high impact activities (running, jumping, etc.), weight bearing (wearing IBA, flak vest, etc.), lifting, bending, prolonged sitting and prolonged standing. Pain was temporarily relieved by continually changing positions. Physical examination showed ambulation without an assistive device or limp; and normal spinal contour. Muscle spasm and guarding were absent, but tenderness and painful motion were present. There was no change in range-of-motion (ROM) with three repetitions.

At the VA Compensation and Pension exam on 14 November 2008 (6 weeks prior to separation), the CI complained of back stiffness and limited motion. He reported constant, sharp LBP with radiation to the right knee and occasional numbness in the right hip and leg. The CI denied incapacitating episodes during the previous 12 months, but reported infrequently using a cane for assistance. Examination showed an erect posture, normal gait and full ROM with dressing and undressing. Muscle spasm and guarding were not noted. Lumbar spine tenderness and painful motion were present, but there was no additional limitation with repetitive motion.

The goniometric ROM evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.

Thoracolumbar ROM
(Degrees)		 NARSUM ~3 Mo s . Pre-Sep
 VA C&P ~1 Mo. Pre-Sep
Flexion (90 Normal) 60 70
Extension (30) 15 25
R Lat Flexion (30) 2 5 20
L Lat Flexion (30) 30 20
R Rotation (30) 30 20
L Rotation (30) 30 20
Combined (240) 1 9 0 175
§4.71a Rating 20% 10%

The B oard directs attention to its rating recommendation based on the above evidence. The PEB assigned a 20% under the 5237 code (lumbar strain) for limitation of motion, while the VA rated the condition at 10% using the 5243 code (intervertebral disc syndrome). Board members agreed that, based on the limitation of motion in evidence on the respective exams, the corresponding ratings by the PEB and VA were appropriate . Other routes to a rating higher than the PEB’s 20% were considered, but there was no evidence of additional functional loss from repetitive use to warrant application of VASRD § 4.45; and no evidence of incapacitating episodes that would justify a minimum rating under the alternative formula for rating intervertebral disc disease. 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 low back pain 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 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 20131105, w/atchs
Exhibit 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, AR20150002652 (PD201302331)

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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