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AF | PDBR | CY2013 | PD-2013-02473
Original file (PD-2013-02473.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXX  CASE: PD-2013-02473
BRANCH OF SERVICE: Army  BOARD DATE: 20140730
SEPARATION DATE: 20021108


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (95B10/Military Police) medically separated for back pain. 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 U3 profile and referred for a Medical Evaluation Board (MEB). The back pain condition was characterized as “degenerative arthritis of the lumbar spine” and was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. No other conditions were submitted by the MEB. The Informal PEB adjudicated “back pain” as unfitting, rated 10%. The CI made no appeals and was medically separated.


CI CONTENTION: The CI makes no contentions.


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 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 20020626
 VA - based on Service Treatment Records (STR)
Condition
 Code Rating Condition Code Rating Exam
Back Pain…… 5299-5295 10% Disc Space Narrowing and Arthrosis, L4/5 and L5/S1 (claimed as bone disease with arthritis in the lower spine) 5292 10% STR
No Other Item in Scope
 No Other Items
Combined: 10%
 Combined: 10%
Derived from VA Rating Decision (VA RD ) dated 200 21111 ( most proximate to date of separation ).


ANALYSIS SUMMARY:

Back Pain Condition. The service treatment record (STR) indicated the CI started to have pain in the back, which seemed to lock up after arising from sitting in the July of 2000. There was no history of injury or associated accident. She saw a physical therapist, who raised the issue of a “blocked” right sacroiliac joint with the recommendation that the CI consult with a chiropractor, but the she elected not to do so. She had chronic back discomfort that varied in intensity depending on her activity level and was issued temporary profiles, one of which required her to have a sitting job since “it had become difficult to stand for long periods of time.” An examination in the clinic dated 29 March 2001, noted “good ROM” and “full flexion” with pain. X-rays of the low back performed on 23 November 2001, demonstrated increased lordosis (sway back), with “significant arthrosis” and slight disc narrowing at L4-5 and L5-S1. The radiologist stated that impingement of nerve roots by bone spurs may be present. Treatment with pain medications (non-steroidal anti-inflammatory medication and Tylenol with codeine) and muscle relaxant medication did not provide sufficient pain relief and even after temporary profiles, she was not able to perform the duties of a military police (running, carrying a pistol belt, or lifting). The MEB examination dated 19 March 2002 indicated the spine examination as “normal” without any detail. A bone scan also dated 22 March 2002, stated “normal study with no evidence of an inflammatory arthropathy involving the spine, sacroiliac joints, nor any other joints of the body”. The MEB narrative summary (NARSUM) dated 22 March 2002 was prepared by a rheumatologist who evaluated the CI on 15 January 2002. The MEB NARSUM restated information from the January 2002 consultation and included new information present in the record including the bone scan and MEB examination. The MEB NARSUM recorded complaint of chronic recurrent low back pain for 18 months without radiation of pain. The back was more sore in the evening than in the morning. The pain was aggravated by prolonged standing, walking, running, lifting and the physical training test. On examination there was tenderness of the spinous processes and pain with motion of the low back. Straight leg raise was negative for radicular signs or symptoms and reflexes were normal. The rheumatologist reviewed laboratory results and X-rays, concluded diagnosis of degenerative arthritis of the spine. A permanent U3 profile for back pain (degenerative arthritis) dated 24 May 2002, indicated limitations including no mandatory standing, walking, or running for over 10 minutes with a limit of lifting up to 15 pounds.

There was no VA examination proximate to separation. According to the VA rating decision 11 November 2002, the CI was unable to be examined for VA purposes because she was pregnant. No additional VARDs noted since 11 November 2002 or Compensation and Pension (C&P) examinations were submitted for review.

The Board directs attention to its rating recommendation based on the above evidence. The IPEB rated the unfitting back pain (with degenerative arthritis of the spine) as 10% using code 5299-5295 (lumbosacral strain) citing characteristic pain on motion. The VA rated the back pain condition based on the STR and adjudicated a 10% rating coded 5292 (limitation of motion, lumbar spine) citing absence of evidence of moderate limitation of motion. The Board notes that the 2002 VASRD standards for the spine, which were in effect at the time of the CI’s separation, were changed to the current §4.71a rating standards in 2004. The Board must correlate the above clinical data with the 2002 rating schedule (applicable diagnostic codes include: 5292 limitation of lumbar spine motion; 5293 intervertebral disc syndrome based on incapacitating episodes; and 5295 lumbosacral strain). The Board agreed that a 20% ratin g was not warranted since ther e was no documentation or range-of- motion (ROM) measurements in the STR of “ moderate limitation of the lumbar spine ” using code 5292 or “ muscle spasm on extreme forward bending , l oss of lateral spine motion, unilateral, in a standing position ” using code 5295. There were no incapacitating episodes requiring bed rest prescribed by a physician to support a minimum rating under 5293. There was no associated peripheral nerve impairment for consideration of a separately unfit rating. 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 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. In the matter of the back pain 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 recharacterization of the CI’s disability and separation determination.


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20131101, 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 XXXXXXXXXXXXXXX, AR20150002940 (PD201302473)

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

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