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AF | PDBR | CY2013 | PD-2013-02490
Original file (PD-2013-02490.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXX  CASE: PD-2013-02490
BRANCH OF SERVICE: Army          BOARD DATE: 20141107
SEPARATION DATE: 20051029


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SSG/E-6 (42A/Administrative Specialist) medically separated for chronic back pain. The back condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS) or satisfy physical fitness standards. He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB). The chronic low back pain condition, characterized as “lumbar degenerative disc disease, with a bulging disc at L5 to S1” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. No other conditions were submitted by the MEB. The Informal PEB (IPEB) adjudicated “chronic back pain, due to lumbar degenerative disc disease, without neurologic or electro diagnostic abnormality” as unfitting, rated at 10%. The CI made no appeals and was medically separated.


CI CONTENTION: “All conditions weren’t evaluated. Service members should have been eligible for medical retirement.”


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 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.

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 Veterans Affairs Schedule for Rating Disabilities (VASRD) standards, based on ratable severity at the time of separation.


RATING COMPARISON :

Service IPEB – Dated 20050920
 VA - (6 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Chronic Back Pain, Due To Lumbar Degenerative Disc Disease 5299-5242 10% Lumbar Spine Strain 5237 10% 20060414
Other x 0 (Not in Scope)
 Other x 7 20060414
Rating: 10%
 Combined Rating: 20%
Derived from VA Rating Decision (VA RD ) dated 20060727 (most proximate to date of separation)



ANALYSIS SUMMARY:

Low Back Condition. Absent of direct trauma, the CI first reported low back pain (LBP) in July 2004 and that was persisted throughout the balance of his service career. He initially reported intermittent LBP with associated bilateral leg pain aggravated with prolonged standing and sitting. Radiologic workup revealed mild lumbosacral disc disease without evidence of foramen (entrance for spinal nerve) narrowing. Secondary to continued subjective leg symptoms, the CI underwent electro-diagnostic testing in April 2005 which was normal. Multiple treatment modalities (including physical therapy and medications) were pursued and the initial temporary profile was issued in May 2005. Absent neurologic abnormality, surgery was not indicated. There were no periods of incapacitation.

At the MEB narrative summary (NARSUM) examination on 23 August 2005, 2 months prior to separation, the CI reported an inability to perform the duties of his MOS due to symptoms of persistent LBP. The physical examination (PE) revealed painful and limited range-of-motion (ROM) without the presence of spinal tenderness or spasms. There was no comment in regards to any associated radicular symptoms. There was decreased ROM. His diagnosis was Lumbar degenerative disc disease and his pain rating was described as “slight” and “frequent”.

At the VA Compensation and Pension (C&P) exam dated 14 April 2006, 6 months after separation, the CI reported stiffness and weakness in his back. Aggravating factors included heavy lifting and prolonged sitting. He reported occasional numbness in his low back and that flare-up twice a week, each episode lasting about 60 to 90 minutes. His functional assessment was described as, “he gets out of bed okay and he can do all of his daily-living needs such as shaving, grooming, feeding and dressing”. There was inconsistent subjective evidence in regards to pain and or numbness into his left leg. The PE revealed the absence of spasms, negative strait leg raise and normal neurovascular findings. There was decreased ROM. 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)		 PE ~ 5 Mo. Pre-Sep
(200 50524 )
MEB ~ 4 Mo. Pre-Sep
(200 50 823 )
VA C&P ~ 6 Mo. Post-Sep
(200 60414 )
Flexion (90 Normal) 80 80 75
Combined (240) 2 25 21 5 215
Comment painful motion painful motion painful motion
§4.71a Rating 10 % 10 % 10 %
       
The Board directs attention to its rating recommendation based on the above evidence. Although the PEB and VA titled the unfitting back condition slightly differently, they both utilized (in various combinations) similar primary codes of 5242 (degenerative arthritis) and 5237 (lumbosacral strain) respectively; both citing limited motion. Board members agreed the limited flexion ROM and combined ranges justifies a 10% rating and no higher. 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 LBP condition. The Board additionally considered if the residual symptom of left leg radiculopathy warranted additional disability rating; however, members agreed that the requisite link of the condition with functional impairment was not in evidence and, the Board cannot support a recommendation for an additional disability rating on this basis. The pain component of any radiculopathy is subsumed under the general spine rating as specified in §4.71a and noted above.


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 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 recharacterization of the CI’s disability and separation determination.


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20131115, 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, AR20150002937 (PD201302490)

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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