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AF | PDBR | CY2013 | PD-2013-02682
Original file (PD-2013-02682.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXXXX       CASE: PD-2013-02682
BRANCH OF SERVICE: Army  BOARD DATE: 20150813
SEPARATION DATE: 20050510


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-3 (Petroleum Supply Specialist) medically separated for lower back. The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty. The profile allows for an alternate aerobic event to satisfy physical fitness standards. He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB). The “chronic low back pain” and “lumbar spondylolisthesis” were forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. No other condition was submitted by the MEB. The Informal PEB adjudicated “chronic back pain…” as unfitting, rated 10%, with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD). The CI made no appeals and was medically separated.


CI CONTENTION: He contends his Veterans Administration (VA) rating reflects seven conditions related to his Service-connected back injury. His complete submission is at Exhibit A.


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 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 20050412
 VA* - (~2 Mos. Pre-Separation)
Condition
 Code Rating Condition Code Rating Exam
Chronic Back Pain… 5239 10% Degenerative Disease, Thoracolumbar Spine 5242 10% 20050317
Other MEB/PEB Conditions x 0
Other x 2
RATING: 10%
 RATING: 10%
* Derived from VA Rating Decision (VA RD ) dated 200 50514 (most proximate to date of separation [ DOS ] ) .


ANALYSIS SUMMARY:

Chronic Back Pain. The narrative summary (NARSUM) documented that in August 2004 (approximately 9 months prior to separation) the CI while riding a horse, fell and began experiencing low back pain (LBP). The neurosurgeon documented the CI reported he was riding a horse when it reared up and fell over on top of him. He did not seek emergency treatment at the time but was seen on sick call the following day, and was treated with pain medication and placed on temporary profile. Radiographs of the lumbar spine sowed deformity of L5 that appeared to be a congenital or chronic finding, and there was a “questionable pars defect”, and Grade I anterolisthesis of L5 and S1 (anterior displacement of a vertebra). A computerized tomography (CT) scan demonstrated bilateral spondylolysis with Grade I spondylolisthesis of L5 and S1. Subsequent magnetic resonance imaging (MRI) in September 2004 recorded L5-S1 severe right foraminal stenosis with moderate left foraminal stenosis and mild spinal canal stenosis secondary to a combination of annular bulge with bilateral foraminal components; right greater than left, and facet hypertrophy. There was also spondylolytic Grade II, and spondylolisthesis of L5 relative to S1. Additionally, L4-L5 showed severe right foraminal stenosis, mild spinal canal stenosis and mild left foraminal stenosis also due to annular bulge with larger right foraminal component and bilateral facet hypertrophy, and mild anterolisthesis of L5 relative to L4. L4/5 and L5-S1 disk desiccation was noted. The lumbar alignment and vertebral body heights were otherwise maintained. Approximately 2 weeks after the MRI, the CI presented to the emergency room with complaint of back pain. He was treated and released and prescribed 48 hour quarters. He underwent consultation with chiropractic medicine, physical therapy, and was prescribed medication for his pain, including steroid injections without significant improvement. In November 2004 neurosurgery consult recorded the CI’s report of back pain with radiation down into the right hip, lateral knee, right ankle, and into the dorsum of the right foot. His back and leg pain had improved significantly overtime. His symptoms are aggravated with movement, and he had received treatment with narcotics, non-steroidal anti-inflammatories, anti-depressant and anti-anxiety medications, and had chiropractic care; all had helped “a little.” Physical examination documented normal muscle strength and tone, except “slightly diminished right tibialis anterior muscle and extensor halluces longus” (tibialis in anterior compartment of the leg and attaches from the tibia shaft to the bone in the foot). Sensation was intact, reflexes reduced, and straight leg raise was negative. He had pain with flexion of the hip. The diagnoses of lumbar radiculitis involving the right L4-L5 nerve roots, spondylolisthesis (degenerative versus congenital), and lumbar spinal stenosis, severe at L4-L5-S1 on the right, were recorded. Surgical options were discussed; however, indicated he was not interested in surgery at the time.

At the NARSUM dated 3 March 2005, physical examination documented range-of-motion (ROM) lumbar spine forward flexion to 80 degrees (NL=90), extension to 10 (30), and a combined ROM of 220 degrees (240). Radicular signs and spasms were absent and muscle strength was recorded as good and he could heel and toe walk without difficulty. Sensory examination was normal; there was no evidence of lower extremity muscle atrophy, or vascular compromise to lower extremities. His gait was recorded as slight antalgic, and he was noted to display discomfort during full forward flexion and extension. The examiner opined that his pain was of moderate intensity, and constant in frequency (American Medical Association pain guidance), and recorded the diagnoses of chronic LBP and lumbar spondylolisthesis. It was noted the origin of the spondylolisthesis remained unclear (acquired versus congenital).

The VA Compensation and Pension exam accomplished 3 weeks prior to separation and documented thoracolumbar spine forward flexion to 70 degrees, and extension to 10 degrees with pain, and additional limitation based on pain after repetitive use without fatigue, weakness, lack of endurance or incoordination. The examiner reported absence of intervertebral disc syndrome.

The Board directed attention to its rating recommendation based on the above evidence. The PEB rated the condition 10%, coded 5239 (spondylolisthesis or segmental instability) with the citation of without neurologic abnormality. The VA used a different code, 5242 and assigned a 10% rating based on ROM. A higher rating of 20% which requires spasms producing abnormal gait, or abnormal curvature of the spine, or forward flexion not greater than 60 degrees, was not supported by the available evidence. There was no evidence of incapacitating episodes for a higher rating under 5243. There is no VARSD pathway to a rating higher than the minimal compensable 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 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 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 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 20131211, w/atchs
Exhibit 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 XXXXXXXXXXXXXXXXXXXX , AR20150015757 (PD201302682)

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

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