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AF | PDBR | CY2013 | PD-2013-02386
Original file (PD-2013-02386.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXX          CASE: PD-2013-02386
BRANCH OF SERVICE: ARMY           BOARD DATE: 20140820
SEPARATION DATE: 20040818


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (91Q/Pharmacy Specialist) medically separated for chronic low back and right hip conditions. The CI injured her back and right hip and the conditions 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). No other conditions were submitted by the MEB. The MEB also identified and forwarded two other conditions for Physical Evaluation Board (PEB) adjudication. The Informal PEB characterized her conditions as “chronic subjective low back pain (LBP)” and “right greater trochanteric bursitis” and adjudicated them both as unfitting, and rated them at 10% and 0%, respectively, with application of 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: “Allergies 0% - I suffer from allergies the whole year round. I have asthma secondary to allergies. But rating is zero. Also my lower back needs to be increased, condition go worse.”


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 ratings for the unfitting low back and right hip conditions are 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 20040616
 VA - (Exam ~ 3 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Chronic Subjective LBP 5299-5242 10% DDD L5-S1 5242 10% 20050131
Right Greater Trochanteric Bursitis 5019 0% Right Trochanteric Bursitis 5019 10% 20041119
Other x 0 (Not in Scope)
 Other x 5 (Not in Scope) 20041119
Combined: 10%
 Combined: 50%
Derived from VA Rating Decision (VA RD ) dated 200 50217 (most proximate to date of separation [ DOS ] ).


ANALYSIS SUMMARY:

Chronic Low Back Condition. The CI fell on ice on 24 January 2000 and subsequently developed LBP which persisted despite conservative management including medications, duty modification, physical and chiropractic therapy and steroid injections. A magnetic resonance imaging of the lumbar spine on 31 March 2003 was significant for multi-level degenerative disc disease (DDD) without frank herniation. An evaluation in physical medicine and rehabilitation on 1 April 2004 documented normal lumbar range-of-motion (ROM). The CI could not be rehabilitated sufficiently to meet duty requirements and was entered into the MEB process. The narrative summary (NARSUM) was dated 14 May 2004, 3 months prior to separation. It noted that she fell in 1998 rather than the 2000 date obtained from the clinical notes in evidence. Regardless, she reported continued pain despite over a year of treatment. On examination, she was noted to walk without pain. The lumbar ROM was full and unrestricted, but the movement exacerbated her LBP. Sensory, motor and reflex examinations were normal. Provocative testing of the nerve roots was negative. At the MEB examination, the CI reported constant LBP. The MEB physical examination revealed a slight loss in the ROM of the back. Formal ROM measurements were obtained the next day on 21 May 2004 and are charted below. She issued an L3 profile on 24 May 2004 for LBP and right hip pain (chronic greater trochanteric bursitis). At the VA Compensation and Pension (C&P) general examination, she reported that she could walk 2 miles, but had recently gotten “lazy.” She denied incapacitation. She also reported difficulty with stairs, but lived on the third floor and was able to tolerate it. She did not use an assistive device. She walked slowly, but without pain. She needed assistance to get up from the examination table. Spasm was absent and the neurological examination was normal. The ROM was reduced as noted below. At the VA C&P spine examination performed 5 months after separation, the CI reported that she was working full time as a pharmacy technician. Walking was limited to 1/2 mile. Incapacitation was not recorded and no use of assistive devices was recorded. The sensory and motor examinations were normal; spasm was absent. The ROM is charted below. She had DDD and degenerative joint disease on X-rays. 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)		 MEB ~3 Mo. Pre-Sep VA General
C&P ~ 3 Mo. Post-Sep		 VA Spine
C&P ~ 5 Mo. Post-Sep
Flexion (90 Normal) 90 40 80
Combined (240) 235 150 220
Comment Heel and toe walk normal Limited by pain No change on repetition
§4.71a Rating 10 % 20 % 10 %

The Board directs attention to its rating recommendation based on the above evidence. The PEB and VA both rated the back condition at 10% using the code for degenerative arthritis, 5242, although the VA did so analogously. The Board noted that the initial ROM measurements for the VA support a 20% rating, but the other two measurements and the physical medicine evaluation all warrant a 10% rating. There was no spasm present or incapacitation to support a rating higher than the 10% adjudicated by both the PEB and MEB. The preponderance of evidence supports the 10% adjudication. 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 back condition.

Right Hip Condition. The right greater trochanteric bursitis dates to the same fall which led to the LBP. Again, conservative management including medications, duty modification, physical therapy and injections was unsuccessful. The hip X-rays on 13 April 2004 were normal. The CI reported at the NARSUM her hip pain was aggravated by twisting movements and by prolonged walking. The greater trochanteric bursa was tender to palpation and the pain aggravated by ROM movements. At the MEB examination, the ROM was normal. At the initial VA C&P examination, the CI reported pain with any motion of the hip. No incapacitation was noted. She reported pain with the toe and heel walk. The right trochanteric area was tender. The ROM is documented below. In the spine examination which was 5 months after separation, she had a slight limp. She noted pain at the end of the ranges of motion; the ROM values are documented below. 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.

“
Right Hip (Thigh) ROM
(Degrees)		 NARSUM ~3 Mo. Pre-Sep VA C&P ~3 Mo. Post-Sep
Flexion (125 Normal)Normal” 60
Extension (20) 10
External Rotation (45) ---
Abduction (0-45) 15
Adduction (45) 15
Comment *All measurements stated as “subjective”
§4.71a Rating 0 % 10 %

The Board directs attention to its rating recommendation based on the above evidence. Bursitis is coded 5019 and utilizes the rating criteria outlined for the VA code 5003 (degenerative arthritis). Absent incapacitation, no rating higher than the 10% adjudicated by both the PEB and VA can be supported using the 5019 code for bursitis. The Board found no route to a higher rating than the 10% adjudicated by the PEB. 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 right greater trochanteric bursitis 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 back and right hip conditions 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 20131107, 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, AR20150003234 (PD201302386)

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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