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AF | PDBR | CY2013 | PD-2013-02555
Original file (PD-2013-02555.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXX     CASE: PD-2013-02555
BRANCH OF SERVICE: Army  BOARD DATE: 20141014
SEPARATION DATE: 20050511


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (92Y/Unit Supply Specialist) medically separated for chronic subjective back pain without neurologic abnormality. The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty 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 (LBP) condition characterized as “does not meet the retention standards” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. No other conditions were submitted by the MEB. The Informal PEB adjudicated chronic back pain as unfitting, rated 10%. The CI made no appeals and was medically separated.


CI CONTENTION: “Lower Back”


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 low back pain condition is addressed below; 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 20050321
 VA - (1 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Chronic Subjective Low Back Pain 5299-5242 10% Herniated Nucleus Pulposus, at L5-S1 (claimed as chronic low back pain) 5243 10% 20050611
Other x 0 (Not in Scope)
 Other x 1
Combined: 10%
 Combined: 20%
Derived from VA Rating Decision (VA RD ) dated 200 51228 ( most proximate to date of separation [ DOS ] ).


ANALYSIS SUMMARY:

Chronic Low Back Pain Condition. The first entry in the clinical record is from a non-traumatic 6-9/10 for LBP of acute onset and a normal physical examination on 1 August 2003. A family practice note on 6 May 2004 documented a 9-month history of constant back pain after his back was hit by someone’s knee. Back pain was worse when bending and running. The CI was treated with non-steroidal anti-inflammatory medications, trigger point injections, physical therapy and chiropractic care, without significant response. A chiropractic note on 27 August 2004 documented LBP prior to deployment (August 2003-March 2004) and range-of-motion (ROM) of flexion 90 degrees, combined ROM 235 degrees with some pain at extension, right lateral and right rotation. A magnetic resonance imaging study found a L5-S1 small broad based disk protrusion, and minimal spondylosis at the same L5-S1 level. The CI was referred to orthopedics on 10 December 2004 and no surgical indications were noted in that consultation. Physical therapy ROM measurements with obtained with a bubble goniometer, performed on 13 January 2005. The “trunk” flexion was 110 degrees, combined ROM measurements was 220 degrees, all limited by pain. There were no normal values, or specific technique used or specified.

The narrative summary (NARSUM) performed on 23 February 2005, noted chronic back pain of more than a year after hand-to-hand combat training that worsened while deployed to Iraq. Pain was described as 5-8/10 constant dull aching and occasionally sharp across the lower back mostly non-radiating associated with spasms and stiffness depending on the type of activity. Worse with prolonged standing, walking, sitting, running, sit-ups, push-ups, lifting, bending and wearing military gear. NARSUM physical examination revealed right greater than left tenderness over the lumbosacral paraspinal muscles. There were negative straight leg raising tests for radiculopathy, normal gait, able to tip-toe and heel walk, negative FABERE (flexion, abduction, external rotation and extension test for sacroiliac and hip dysfunction), normal ROM of the extremities, normal strength, normal deep tendon reflexes, and normal sensation. “Trunk” ROM was referred to the physical therapy note noted above.

At the VA Compensation and Pension exam performed on 6 June 2005, a month after separation, the CI reported no incapacitating episodes or flare-ups of pain in the back. Physical examination revealed a mildly positive straight leg-raising test (for radiculopathy) on the right, mild right paralumbar muscle spasm. There was no reflex, sensory or motor deficits. ROM was flexion 90 degrees, combined ROM measurements of 175 degrees. There was no increase of pain, fatigability, weakness, or lack of endurance with repeated movements.

The Board directs attention to its rating recommendation based on the above evidence. The Board considered VASRD diagnostic code 5299 (rated analogously to) – 5242 (degenerative arthritis of the spine, used by the PEB for a 10% rating. The Board did not find evidence for a higher 20% rating using the VASRD General Rating Formula for Diseases and Injuries of the Spine such as, evidence of forward flexion of the spine greater than 30 degrees, but not greater than 60 degrees, or a combined thoracolumbar ROM not greater than 120 degrees, or abnormal gait, or abnormal spinal contour. The Board also considered code 5243 (intervertebral disc syndrome) used by the VA, also for a 10% rating. There were no incapacitating episodes found in the evidence for a higher rating under code 5243. The General Rating Formula for Diseases and Injuries of the Spine subsumes 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. The Board considered alternate codes such as 5003 (degenerative arthritis) and 8720 (sciatic nerve neuralgia) but found no rating advantage. 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 LBP condition.


BOARD FINDINGS: 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 subjective 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 20131122, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record




                 
XXXXXXXXXXXXXX
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 XXXXXXXXXXXXXX, AR20150006483 (PD201302555)

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

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