Search Decisions

Decision Text

AF | PDBR | CY2013 | PD-2013-02384
Original file (PD-2013-02384.rtf) Auto-classification: Approved
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXX CASE : PD -20 13 - 02384
BRANCH OF SERVICE: Army BOARD DATE: 201 4 0731
Separation Date: 20060226


SUMMARY OF CASE : Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (91E10/Dental Assistant) medically separated for a chronic back condition. The condition could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty or satisfy physical fitness standards. She was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB). The low back condition, characterized as “low back pain (LBP) – extruded discs with myofascial pain” and “back pain, degenerative disc disease (DDD),” were forwarded to the Physical Evaluation Board (PEB) as not meeting retention standards IAW AR 40-501. The MEB forwarded no other conditions to the PEB. The Informal PEB adjudicated “chronic back pain due to lumbar degenerative disc disease/extruded discs” as unfitting and rated it at 10% with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD). The CI made no appeals and was medically separated.


CI CONTENTION : “I was unable to continue my service in the Army due to my back conditions. This rating should be reconsidered.”


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 back 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 20051213
 VA - (<1 Mo. Pre-Separation)
Condition
 Code Rating Condition Code Rating Exam
Chronic Back Pain Due to Lumbar DDD/Extruded Discs 5299-5242 10% DDD Lumbar Spine w/S-1 Radiculopathy Lower Extremities 5242 20% 20060210
Other x 0 (Not in Scope)
 Other x3 20060210
Combined: 10%
 Combined: 30%
Derived from VA Rating Decision (VARD) dated 20060616 (most proxi mate to date of separation )


ANALYSIS SUMMARY : The Disability Evaluation System ( DES) is responsible for maintaining a fit and vital fighting force. While the DES considers all of the member's medical conditions, compensation can only be offered for those medical conditions that cut short a member’s career and then only to the degree of severity present at the time of final disposition. However the Department of Veteran Affairs, operating under a different set of laws (Title 38, United States Code), is empowered to compensate service - connected conditions and to periodically re-evaluate said conditions for the purpose of adjusting the V eteran’s disability rating should the degree of impairment vary over time.

Chronic Back Pain Due To Lumbar DDD/Extruded Discs Condition . The CI gradually developed LBP , without a specific injury noted, during basic training course in March 2003. The lumbar sp ine X -ray showed a straightening of the lordotic curve. The CI was followed by fam ily practice throughout 2003 for continued chronic LBP. A lumbar spine magnetic resonance imaging demonstrated a moderate sized right pericentral disc extrusion at the L4-5 level , which significantly com pressed the right L5 nerve root, touches the left L5 nerve root with mild spinal canal stenosis, small disc bulge at L4-5 and L5-S1 levels with DDD at the L4-5 and L5-S1 levels. The orthopedist documented that the CI reported some right leg tingling and numbness th at radiated down to her mid-calf which improved with time. The physical exam finding s were intact motor and sensory minimal tenderness to palpation also pain with flexion. The spine surgeon documented LBP , right - sided leg pain with paresthesia s and numbness in the legs. The physical exam findings were normal muscle strength with a light touch sensory deficit in the right L5 distribution. The examiner advised physical therapy (PT) and epidural steroid injections (ESI) ; ESI was performed on 7 February 2005 . The PT documented that the CI reported LBP with right lower extremity pain, numbness with tingling in the toes primarily while running, walking and prolonged standing. The physical exam ination findings were normal muscle strength, mild tenderness over the lumbar area decreased sensation in the right S1 dermatome . The MEB narrative summary (NARSUM) exam ination ( approximately 4 months prior to separation ), documented chronic LBP with occasional radiation to the right lower extremity. The symptoms worsened with activities such as prolonged sitting, running, jumping wearing/carrying military gear a n d bending/twisting activities. The examiner opined that the severity of the symptoms had not responded to treatment and the anticipated prognosis for recovery was poor. The MEB NARSUM physical exam ination findings are summarized in the chart below .

The VA Compensation and Pension (C&P) exam approximately 17 days prior to s e paration documented that the CI had a constant, dull ache in the lower back with increased discomfort with prolonged standing, walking, bending, lifting and pain radiating from the lower back into both legs. The VA C&P physical exam findings are summarized in the chart below .

There were two range-of- motio n (ROM) evaluations in evidence with documentation of additional ratable criteria, which the Board weighed in arriving at its rating recommendation; as summarized in the chart below.
Thoracolumbar ROM (Degrees) PT 5 M os . P re -S ep MEB 5 Mo s . Pre-Sep VA C&P 16 Days Pre-Sep
Flexion (90 Normal) 65 Used ROM’s from PT exam 60
Combined (240) 210 210
Comment Pos. painful motion Pos. tenderness to palpation lumbar paraspinal muscles ; decreased flexion; Normal gait; Neg. straight leg raise N ormal gait ; Pos. loss of normal curvature lower back; No spasm; Normal motor/sensory/reflexes
§4.71a Rating 10% 10 % 20 %
invalid font number 31502
invalid font number 31502 The Board directs attention to its rating recommendation based on the above evidence. invalid font number 31502 The PEB invalid font number 31502 coded the chronic back pain due to lumbar degenerative disc disease / extruded disc condition invalid font number 31502 invalid font number 31502 as 5299 analogous to invalid font number 31502 5242 invalid font number 31502 invalid font number 31502 ( invalid font number 31502 degenerative invalid font number 31502 arthritis of the spine invalid font number 31502 ) invalid font number 31502 and rated at 10%. The VA coded the invalid font number 31502 degenerative disc disease invalid font number 31502 /lumbar spine with S invalid font number 31502 1 radiculopathy invalid font number 31502 of invalid font number 31502 lower extremities invalid font number 31502 invalid font number 31502 condition as 5142 and rated at 20%. invalid font number 31502 invalid font number 31502 The General Rating Formula for Diseases and Injuries of the Spine considers the CI’s pain symptoms “ invalid font number 31502 with invalid font number 31502 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 invalid font number 31502 .” invalid font number 31502 The invalid font number 31502 service data invalid font number 31502 was invalid font number 31502 5 invalid font number 31502 months prior to separation and was consistent with the 10% rating as conferred by the PEB. The invalid font number 31502 C invalid font number 31502 & invalid font number 31502 P exam which was invalid font number 31502 performed invalid font number 31502 17 days prior to separation invalid font number 31502 , invalid font number 31502 met the 20% rating criteria for forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees. invalid font number 31502 The ROM measurements documented on both exams were within invalid font number 31502 5 invalid font number 31502 degrees of each other invalid font number 31502 . Board members agree invalid font number 31502 t invalid font number 31502 hat the C&P exam was most probative due to its proximity to the day of invalid font number 31502 separation. invalid font number 31502 The pain component of a radiculopathy is subsumed under the general spine rating as specified in §4.71a. invalid font number 31502 invalid font number 31502 The sensory component in this case ha invalid font number 31502 d invalid font number 31502 no functional implications. There was no motor impairment present. Since no evidence of functional impairment exists in this case, the Board cannot support a recommendation for additional rating based on peripheral nerve impairment. invalid font number 31502 invalid font number 31502 After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating invalid font number 31502 of 20% for invalid font number 31502 invalid font number 31502 the chronic back pain invalid font number 31502 due to lumbar degenerative disc disease invalid font number 31502 / invalid font number 31502 extruded discs invalid font number 31502 condition invalid font number 31502 invalid font number 31502 without any additional rating for a peripheral neuropathy condition invalid font number 31502 . invalid font number 31502


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 back pain due to lumbar degenerative disc disease / extruded discs condition , the Board unanimously recommends a disability rating of 20 %, coded 5299-5242 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 her prior medical separation:

UNFITTING CONDITION VASRD CODE RATING
Chronic Back Pain Due to Lumbar DDD/Extruded Discs 5299-5242 2 0%
COMBINED 2 0%
invalid font number 31502

The following documentary evidence was considered:
Exhibit A. DD Form 294, dated 20 131114 , 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, AR20150002545 (PD201302384)
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

Similar Decisions

  • AF | PDBR | CY2014 | PD-2014-01741

    Original file (PD-2014-01741.rtf) Auto-classification: Approved

    The Informal PEB adjudicated “lumbar degenerative disc disease without neurologic abnormality” as unfitting, rated 10%, with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD). 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 VA coded the lumbar spine DDD condition as 5242 and...

  • AF | PDBR | CY2013 | PD2013 00161

    Original file (PD2013 00161.rtf) Auto-classification: Approved

    The ratings for the unfitting neck and back conditions are addressed below. The PT note on 16March 2007, 3 months prior to separation recorded bubble inclinometer ROM without specification of the method used, or normal values, at flexion 21 degrees, and extension 9 degrees with pain.The MEB NARSUM exam on 23 April 2007, approximately2 months prior to separation, documented that the CI’s LBP symptoms had slowly worsened and that he had undergone rest, activity modification, anti-inflammatory...

  • AF | PDBR | CY2013 | PD-2013-02524

    Original file (PD-2013-02524.rtf) Auto-classification: Approved

    The VA Compensation and Pension (C&P) exam approximately 6.5 months after separation documented that the CI had constant daily neck pain rated at 7/10, neck stiffness occurred with turning the neck to any side with radiation down both upper extremities with feelings of hand weakness during an acute exacerbation. invalid font number 31502 RECOMMENDATION : The Board recommends that the CI’s prior determination be modified as follows; and, that the discharge with severance pay be...

  • AF | PDBR | CY2014 | PD-2014-00452

    Original file (PD-2014-00452.rtf) Auto-classification: Approved

    A review of my medical records will show this. 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. 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-2013-01492

    Original file (PD-2013-01492.rtf) Auto-classification: Denied

    The Board considered the 10% rating criteria – “localized tenderness not resulting in abnormal gait or abnormal spinal contour.” All exams proximate to separation documented paraspinal tenderness at the mid to lower lumbar regions and the only exam with ROM measurements documented normal thoracolumbar ROM.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...

  • AF | PDBR | CY2013 | PD-2013-01730

    Original file (PD-2013-01730.rtf) Auto-classification: Approved

    The VA rated the service connected chronic back condition as degenerative arthritis of the spine (5242-5003) at 10% citing painful motion.Although the PEB and VA used different codes, both codes are rated under the General Rating Formula for Diseases and Injuries of the Spine, based on limitation of thoracolumbar ROM. In the matter of the chronic back pain condition, the Board unanimously recommends a disability rating of 10%, coded 5299-5242 IAW VASRD §4.71a.There were no other conditions...

  • AF | PDBR | CY2012 | PD2012 01647

    Original file (PD2012 01647.rtf) Auto-classification: Denied

    invalid font number 31502 Service FPEB – Dated 20030917VA (# Mo. The PEB used these rules to rate the chronic LBP condition, coded 5295 lumbosacral strain, and initially rated at 10% (with characteristic pain on motion). The Board notes that although they did not change the VASRD code, verbiage contained on the FPEB’s findings and recommendations document suggeststhe FPEB may have utilized VASRD code 5293, intervertebral disc syndrome (also in effect at the time of separation) to arrive at...

  • AF | PDBR | CY2014 | PD 2014 01924

    Original file (PD 2014 01924.rtf) Auto-classification: Denied

    invalid font number 31502 Service IPEB – Dated 20080711VA - based on Service Treatment Records (STR)ConditionCodeRatingConditionCodeRatingExam Lumbar DDD523710%Lumbar DDD with Radiculopathy524220%STROther X 0 (Not in Scope)Other x1 Combined: 10%Combined: 30%Derived from VA Rating Decision (VARD) dated 20090124 (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. A...

  • AF | PDBR | CY2013 | PD-2013-01840

    Original file (PD-2013-01840.rtf) Auto-classification: Denied

    invalid font number 31502 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...

  • AF | PDBR | CY2012 | PD2012 01529

    Original file (PD2012 01529.rtf) Auto-classification: Denied

    The brain trauma and incontinence conditionswere not identified by the MEB or PEB and thus,they are not within the DoDI 6040.44 defined purview of the Board.These and any other condition or contention not requested in this application, remain eligible for future consideration by the BCMR. RECOMMENDATION : The Board, therefore, recommends that there be no recharacterization of the CI’s disability and separation determination, as follows: Physical Disability Board of Review