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AF | PDBR | CY2013 | PD-2013-02665
Original file (PD-2013-02665.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXX     CASE: PD -20 13 - 0 2665
BRANCH OF SERVICE: Army   BOARD DATE: 201 5 0203
Separation Date: 20060711


SUMMARY OF CASE : The evidence of record indicates this covered individual (CI) was an activated Reserve E-5 (Automated Logistical Specialist) medically separated for back pain. This condition could not be adequately rehabilitated to meet the requirements of his Military Occupational Specialty (MOS) although he was authorized to perform alternate physical fitness testing. He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB). Lumbago was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. The MEB also identified and forwarded anxiety disorder for PEB adjudication. The PEB adjudicated “chronic low back pain (LBP) without neurologic abnormality” as unfitting, rated 10%, citing criteria of the Veterans Affairs Schedule for Rating Disabilities (VASRD). The remaining condition w as determined to be not unfitting. The CI made no appeals and was medically separated.


CI CONTENTION : “I was given a higher rating for my back through the Veterans Administration. I believe that the facts that the VA used would prove that I should have been given a higher rating when exiting service.”


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 when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting. Any conditions outside the Board’s defined scope of review and any contention not requested in this application may remain eligible for future consideration by the Board for Correction of Military/Naval Records. Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate. The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation. The Board has neither the role nor the authority to compensate for post-separation progression or complications of service-connected conditions. That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws. The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.


 RATING COMPARISON :

Service IPEB – Dated 20060615
 VA* - (~4 Mos. Pre-Separation)
Condition
 Code Rating Condition Code Rating Exam
Chronic LBP without Neurologic Abnormality 5299-5237 10% Thoracolumbar Degenerative Joint Disease (DJD) / Chronic Bilateral Sacroilitis 5242 10% 20060322
Other x 1 (Not in Scope)
 Other x 5
Combined: 10%
 Combined: 50%
* Derived from VA Rating Decision (VARD) dated 20070625 (most proximate to the date of separation (DOD))
ANALYSIS SUMMARY :

Chronic LBP without Neurologic Abnormality Condition . The CI injured his lower back and underwent surgery for a herniated nucleus pulposus in 1996. He completed extensive rehabilitation therapy and was given a permanent L2 profile in 1996. He was pain free until he was activated in October 2004 and then the LBP restarted from jumping in and out of trucks in full gear. He underwent physical therapy (PT) and deployed. During his deployment, he complained o f LBP and was again referred to PT. He completed his deployment with recommendations of an exercise regimen prescribed by o rthopedics. Once he re - deployed stateside , he underwent a lumbar spine magnetic resonance imaging , which showed moderate to severe narrowing at L5-S1 with a herniated disc that impinge d on the L5 and S1 nerve root s . The n erve conduction s tudy and e lectromyogram was normal . The examiner opined that the CI’s symptoms were more consistent with mechanical back pain from a musculoskeletal source. The CI continued to be c losely followed by both PT and p rimary c are throughout 2006 for chronic LBP with altered gait.

 The VA Compensation and Pension (C&P) exam dated 22 March 2006, approximately 4 months prior to separation , documented morning stiffness, constant squeezing, aching, burning LBP that radiated down both legs rated 6/10 elicited by physical activity and stress. The CI was functionally impaired as he had pain with pushing or pulling any objects that weighed more than 20 pounds. The VA C&P physical exam findings are summarized in the chart below.

 The MEB n arrative s ummary (NARSUM) exam dated 7 April 2006, approximately 3 months prior to separation , documented that the CI was unable to perform his MOS duties and he had difficulty with prolonged walking, hiking or bicycle riding. He had minimal improvement with both PT and c hiropractor care. The examiner rated the pain according to th e American Medical Association pain scale at slight and frequent. The MEB NARSUM physical exam findings are summarized in the chart below.

There were two range - of - motion (ROM) evaluations in evidence, with documentation of additional ratable criteria, which the Board weighed in arriving at its rating recommendation; as summarized in the chart below.

Thoracolumbar ROM (Degrees) MEB NARSUM ~3 Mos. Pre-Sep VA C&P ~4 Mos. Pre-Sep
Flexion (90 Normal) 85 70
Combined (240) 210 195
Comment Normal strength & reflexes; Decreased sensation right upper leg Normal gait; Pos. painful motion; No spasm or tenderness; Pos. straight leg raise on left; Normal strength, sensation & reflexes
§4.71a Rating 10% (PEB 10%) 10% (VA 10%)
invalid font number 31502
The Board direct ed attenti on to its rating recommendation based on the above evidence . The PEB coded the c hronic LBP without n eurologic a bnormality condition as 5299 analogous to 5237 ( l umbosacral or cervical strain ) and rated at 10%. The VA coded the t horacolumbar DJD with n arrowing at L4-5/ c hronic b ilateral s acroilitis condition as 5242 ( d egenerative arthritis of the spine ) also rated at 10%. The General Rating Formula for Diseases and Injuries of the Spine considers the CI’s pain symptoms “with or without 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 CI met the criteria for a 10% rating “Forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees” and “localized tenderness not resulting in abnormal gait or abnormal spinal contour . ” There was no evidence of forward flexion of the thoracolumbar spine greater than 30 degrees, but not greater than 60 degrees; or, a combined ROM of the thoracolumbar spine not greater than 120 degrees for a 20% rating under the G eneral R ating F ormula for the S pine. Additionally, there was no evidence of ratable peripheral nerve impairment , which would provide for additional rating, or documentation of incapacitating episodes which would provide for a higher 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 c hronic LBP without n eurologic a bnormality 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 chronic low back pain without neurologic ab normality 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 20 131213 , w/atchs
Exhib it B. Service Treatment Record
Exhibit C. Department of Veterans ’ Affairs Treatment Record





XXXXXXXXXXXXXXX
President
 DoD 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 , AR20150010575 (PD201302665)


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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