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AF | PDBR | CY2013 | PD-2013-02670
Original file (PD-2013-02670.rtf) Auto-classification: Approved
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXX     CASE: PD-2013-02670
BRANCH OF SERVICE: Army  BOARD DATE: 20150602
Separation Date: 20051124


SUMMARY OF CASE : Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 ( Food Service Operations) medically separated for chronic low back pain. The condition could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty (MOS); however, her physical profile authorized her to perform two alternate aerobic Army Physical Fitness Test events. She was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB). The condition, characterized as “mechanical low back pain (LBP) ” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. No other condition was submitted by the MEB. The Informal PEB adjudicated chronic low back pain as unfitting, rated 0%, with likely application of AR 635-40 . The CI made no appeals and was medically separated.


CI CONTENTION : “Chronic low back pain.”


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 :

IPEB – Dated 20050829
 VA* - (~52 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Chronic LBP… 5299-5237 0% Lumbar Myofascial Pain Syndrome 5237 10% 20100302
Other x 0 (Not In Scope)
 Other x 3
RATING: 0%
 RATING: 10%
*Derived from VA Rating Decision (VARD) dated 20100320 (most proximate to date of separation (DOS)).




ANALYSIS SUMMARY :

Chronic LBP Condition . The CI developed LBP after childbirth in October 2002. She underwent conservative treatment which included physical therapy (PT) and temporary profiles through June 2004 without significant symptom relief. A lumbar spine MRI in June 2004 and a lumbar spine X-ray in August 2004 w ere normal. A repeat lumbar spine X-ray in February 2005 showed very minimal loss of disc space height at L4-5. The commander’s statement indicated that the CI’s chronic LBP kept her from performing her MOS duties. The physical therapist range-of-motion (ROM) evaluations done for the MEB exam were flexion 90 degrees (normal) and a combined 240 degrees (normal) after application of VASRD spine formula note 2 for truncating measurements. The exam documented normal gait with no CI complaints of radiating pain or radiating symptoms. The CI had been seen by chiropractic, given a heel lift (likely for uneven leg length) and was not considered a surgical candidate. The DD Form 2808, Report of Medical Examination , in March 2005 documented sacroiliac tenderness, and a clinic note in May 2005 noted tenderness on palpation of the lower back. The MEB narrative summary (NARSUM) exam approximately 4 months prior to separation documented that the CI could not do sit-ups, repetitive jumping or stooping activities nor could she wear a Kevlar helmet , Kevlar vest , or wear load-bea ring equipment. The physical exam findings were normal gait and diffuse bilateral sacroiliac tenderness, left greater than right.

The VA Compensation and Pension (C&P) exam approximately 52 months after separation noted that the CI’s symptoms wer e mildly suggestive of sciatica - like symptoms. The physical exam findings were a flexion of 90 degrees and a combined ROM of 240 degrees with moderate paraspinal tenderness. Gait was normal without motor, sen sory or reflex abnormalities. A s traight leg raise test (for radicular symptoms) was negative.

The Board directed attention to its rating recommendation based on the above evidence. The PEB coded the c hronic LBP condition as 5299 analogous to 523 7 (l umbosacral strain ) and rated at 0% , with a disability description that noted sacroiliac tenderness and the passive ROMs indicating possible application of AR 635-40 . The VA coded the lumbar myofascial pain syndrome condition as 5237 and rated at 10%. The Board considered the Service exams had the highest probative value for rating and documented tenderness . There was no ROM deficit, and no muscle spasm, abnormal gait , abnormal contour, or p eripheral nerve deficits. 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 Board adjudged that the CI met the 10% criteria under the spine formula for “localized tenderness not resulting in abnormal gait or abnormal spinal contour,” and there was no path to a rating over 10% or for the addition o f a peripheral nerve rating. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the LBP 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. As discussed above, PEB reliance on AR 635-40 for rating the LBP condition was likely operant in this case and the condition was adjudicated independently of that instruction by the Board. In the matter of the LBP condition, the Board unanimously recommends a disability rating of 10 %, coded 5299-5237 IAW VASRD §4.71a. There were no other conditions within the Board’s scope of review for consideration.


RECOMMENDATION : The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of her prior medical separation:

UNFITTING CONDITION VASRD CODE RATING
C hronic LBP 5299-5237 1 0%
COMBINED 1 0%
invalid font number 31502

The following documentary evidence was considered:
Exhibit A. DD Form 294, dated 20 131209 , w/atchs
Exhib it B. Service Treatment Record
Exhibit C. Department of Veterans Affairs Treatment Record




XXXXXXXXXXXXXXXXXXXX
President
Physical Disability Board of Review

invalid font number 31502





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 XXXXXXXXXXXXXXXXXXX , AR20150011450 (PD201302670)
1. 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 to modify the individual’s disability rating to 10% without recharacterization of the individual’s separation. This decision is final.

2. I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum.

3. I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

BY ORDER OF THE SECRETARY OF THE ARMY:




Encl                                                  XXXXXXXXXXXXXXXXXXX
                                                      Deputy Assistant Secretary of the Army
                                                      (Review Boards)

CF:
( ) DoD PDBR
( ) DVA


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