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AF | PDBR | CY2013 | PD-2013-02574
Original file (PD-2013-02574.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXX     CASE: PD-2013-02574
BRANCH OF SERVICE: Army  BOARD DATE: 20141021
SEPARATION DATE: 20050508


SUMMARY OF CASE: The evidence of record indicates this covered individual (CI) was a Reserve MSG/E-8 (21X/General Engineering Supervisor) medically separated for low back pain (LBP). The back condition could not be adequately rehabilitated to meet the requirements of his Military Occupational Specialty or physical fitness standards. He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB). The back condition, characterized as “moderate, constant, chronic low back pain…” 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 (DDD)…” as unfitting, rated 20%. The CI appealed to the Formal PEB, which affirmed the IPEB finding and rating. The CI submitted a rebuttal and refused to make an election and was therefore medically separated with severance pay.


CI CONTENTION: The CI elaborated no contention in his application.


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 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 FPEB – Dated 20050214
 VA - (1 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Chronic Back Pain due to Lumbar Degenerative Disc Disease… 5299-5242 20% Paravertebral Muscle Spasms… 5293-5292 40% VA PN*
Right Leg Radiculopathy… 5293-8520 10% VA PN*
No Additional MEB/PEB Entries in Scope
 Combined: 60%
Combined: 20%
Derived from VA Rating Decision (VA RD ) dated 200 50826 . * VARD evidence based upon VA treatment Progress Notes


ANALYSIS SUMMARY:

Low Back Condition. The narrative summary (NARSUM) dated 20 September 2004 noted the back pain began after the CI fell off an army truck during training in April 2003. He landed on his back (in dirt) and immediately experienced lower back pain. Magnetic resonance imaging (MRI) of the lumbar spine dated 4 August 2003 demonstrated diffuse disc bulge with an inner annular tear at L4-L5 level with associated narrowing of the left neural foramina and multilevel mild degenerative changes posteriorly. Repeat MRI dated 27 September 2004 revealed several small disk bulges and protrusions without significant central canal or neural foramina narrowing at any level. The CI was treated conservatively with medications, transcutaneous electrical nerve stimulation (TENS) unit and physical therapy (PT). He was evaluated by physical medicine and a rehabilitation specialist (physiatrist) in August 2003. At the physiatrist visit on 19 August, the CI reported moderate relief of symptoms with PT treatment. He noted his pain intensity was 4/10, associated with pain in both testicles. At times there was a burning sensation in the posterior thigh and calf. On physical examination, there was noted muscle spasm, bilaterally, in the thoracolumbar paraspinal muscles and tenderness over the lumbosacral paraspinals on the left side. Range-of-motion (ROM) recorded forward flexion of 50 degrees with pain and extension of 15 degrees with pain. Sensory examination was negative. The CI’s recorded ROM, at the physiatry follow-up visit in October 2004, was lumbar forward flexion of 50 degrees with pain. Due to the CI’s report of radicular pain, an electromyogram study was completed and interpreted as normal. Physiatrist completed a duty status report on the CI for his civilian job at the local post office. It noted the CI injured his back in January 2004 from delivering a parcel and that he was unable to perform his job. The CI’s profile indicated he could not participate in Army Physical Fitness Training, was unable to perform all physical activities except for walking at his own pace. The commander’s statement recorded the CI was physically unable to perform his duties. At the NARSUM exam, approximately 8 months prior to separation, the CI reported he had constant lower dull, aching back pain, with an intensity of 8/10. Occasionally he experienced some sharp stabbing pains in the lower back that occasionally radiated into his legs. He could not run and bending caused significant LBP. Physical examination noted the CI ambulated with an assistive device (quad cane). Tenderness was noted on examination of the thoracic and lumbar spines. There was no evidence of neurological deficits or vascular compromise to the lower extremities. The examiner noted PT performed ROM measurements for the MEB and recorded marked reduction of low back motion limited by pain (flexion to 20 degrees limited by severe pain and extension to 10 degrees limited by pain). The physician noted the CI had failed conservative treatment and was not a surgical candidate.

At the VA Compensation and Pension (C&P) exam dated 21 April 2005, approximately 2 weeks prior to separation, the CI reported daily back pain with a duration of 2 to 3 hours and an intensity level of 7/10. The pain was described as “shock like in sensation,” relieved by bed rest and medication. Prolonged standing, sitting and ambulation exacerbated the pain. The CI ambulated with a hemi-walker. He denied a history of losing his balance and falls. He reported he had retired from his postal job due to back pain. Physical examination revealed forward flexion ROM of 50 degrees and extension of 10 degrees, both measurements recorded limited by pain. Tenderness to palpation was observed at the lumbosacral area and paravertebral muscles. There was no evidence of weakness or lack of endurance or fatigue. Muscle strength in the bilateral lower extremity was normal and sensory examination recorded decreased pinprick sensation in the left lower extremity. Muscle spasms were not recorded and the examiner indicated the CI had no spinal deformities. The physician indicated the CI had not experienced incapacitating episodes during the past 12 months.

The Board directs attention to its rating recommendation based on the above evidence. The PEB rated the condition 20% for chronic back pain due to lumbar DDD coded analogously 5299-5242 (limitation of motion). The VA recorded the condition of paravertebral muscle spasms with rightward herniated disc, initially rated at 10%, coded 5293-5292 in 1980 and increased to 40% in 2003, with no increases reflected at the time of separation. A higher rating of 40% requires forward flexion of the thoracolumbar spine of 30 degrees or less; or favorable ankylosis of the entire thoracolumbar spine. The Board undertook a careful review of the record in evidence and encountered a total of four recorded ROM measurements in 2003. The Board noted three of the four recorded flexion ROM of 50 degrees and only one with flexion of 20 degrees recorded as limited by pain. The 20 degrees of flexion reflected the ROM for the NARSUM, 8 months prior to separation. The Board noted the ROM recorded at the C&P examination, 50 degrees of flexion, was consistent with the majority of flexion ROMs recorded in the record, and was most proximal to date of separation. The Board concluded the C&P examination had greater probative value and supported the 20% disability rating. All Board members agreed the 20% threshold was met; however, the 40% threshold was not supported by the evidence. The Board considered a rating under code 5243 (intervertebral disc syndrome); however, there was no evidence of incapacitating episodes for a higher rating. There were no other applicable codes to consider. 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. The Board surmised from the record or PEB ruling in this case that no prerogatives outside the VASRD were exercised. In the matter of the chronic 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 no re-characterization of the disability and separation determination.


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20131126, 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, AR20150006484 (PD201302574)

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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