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AF | PDBR | CY2013 | PD-2013-02706
Original file (PD-2013-02706.rtf) Auto-classification: Approved
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXXXX       CASE: PD-2013-02706
BRANCH OF SERVICE: Army          BOARD DATE: 20150423
SEPARATION DATE: 20070507


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E- 4 ( Wheeled Vehicle Mechanic ) medically separated for low back pain and left shoulder pain. The conditions could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS) or satisfy physical fitness standards. He was issued a permanent U2L3 profile and referred for a Medical Evaluation Board (MEB). The “ lumbar degenerative disc , ” “ back pain limiting activity” and “ SLAP and B ankart lesions ” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. No other condition was submitted by the MEB. T he I nformal PEB (IPEB) adjudicated c hronic radiating low back pain and chronic left (non-dominant) shoulder pain as unfitting, rated 10 % and 0 % respectively , with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) for the back condition and with likely application of the US Army Physical Disability Agency (USAPDA) pain policy for the shoulder condition. The CI made no appeals and was medically separated.


CI CONTENTION: “Only rated 10% for severe low back condition (chronic) rated 10% for l shoulder scar not surgery/shoulder injury”


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 20070302
 VA* - (~1 Mos. Pre-Separation)
Condition
 Code Rating Condition Code Rating Exam
Chronic Radiating Low Back Pain... 5299-5237 10% Degenerative Disc Disease of the Lumbar Spine 5243 10% 20070405
Chronic Left (Non-Dominant) Shoulder Pain... 5099-5003 0% Left Shoulder (Non-Dominant) … Postoperative Residuals … 5299-5203 10% 20070405
Scars; Left Shoulder … 7804 10% 20070405
Other x 0 (Not In Scope)
 Other x 0
RATING: 10%
 RATING: 30%
* Derived from VA Rating Decision (VA RD ) dated 200 70511 (most proximate to date of separation ( DOS ) ) .

ANALYSIS SUMMARY:

Chronic Radiating Low Bac k Pain. The narrative summary (NARSUM) and treatment record noted onset of low back pain (LBP) and left leg pain in 2004 after heavy lifting. Conservative treatment (anti-inflammatory medication, profile restriction, narcotic pain medication) did not relieve his back pain. Imaging (MRI) demonstrated degenerative disc disease with left L-5 nerve impingement and wedging changes. Activities increased his back pain and the CI declined surgery. Treatment notes indicated complaints of tingling and numbness to the lower leg and foot on both sides, with the right leg resolving and the left leg symptoms decreasing following treatment. The commander’s statement, dated 28 December 2006 (approximately 5 months prior to separation) noted that the CI “could not walk too far without his left leg getting numb, 3 outer toes having sharp pain, and the sole of his feet hurting especially in combat boots.” The CI had epidural steroid injections and facet injections with the last performed 16 January 2007 (approximately 4 months prior to separation). At the MEB exam, the CI reported continued back pain with activities. The MEB physical exam noted back tenderness with pain-limited range of motion (ROM) summarized below. Gait was normal and neurologic exam was normal for strength, reflexes, sensory and proprioception testing.

At the VA Compensation and Pension (C&P) exam performed a month prior to separation, the CI reported continued back pain with activities and continued use of anti-inflammatory and muscle relaxant medications. Exam documented limited lumbar spine ROM with back stiffness and mild spasm with a normal gait and spine curvature. There was “no evidence of sciatica” (radiating pain or lower extremity nerve condition).

The Board directed its attention to its rating recommendation based on the above evidence. All exams documented pain-limited motion of the thoracolumbar spine with forward flexion greater than 60 degrees and combined ROM greater than 120 degrees. There was no evidence of periods of incapacitation (physician prescribed bed rest), or muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour for any thoracolumbar spine rating greater than 10%. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends no change in the PEB rating for the chronic radiating low back pain condition.

The Board then considered if there was sufficient evidence of an unfitting and compensable radiculopathy condition. The PEB disability description indicated that radicular symptoms were not unfitting “Radicular symptoms improved with epidural steroid injections and are not separately unfitting.” The commander’s comments on pain with walking in combat boots was noted as prior to the CI’s last injection. Although treatment notes had indicated some left leg numbness, the NARSUM exam performed by a neurologist, and the VA exam did not document any peripheral nerve deficit in the lower extremities. The general spine rating formula includes symptoms such as pain (whether or not it radiates), stiffness, or aching in the area of the spine, and radiating pain was considered in the thoracolumbar 10% rating. There was no objective lower extremity weakness or fixed neurologic deficit proximate to separation. After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the radicular symptoms related to the back condition. The Board concluded therefore that a radiculopathy (peripheral nerve) condition could not be recommended for additional disability rating.

Chronic Left (Non-Dominant) Shoulder Pain . The NARSUM, orthopedic addendum, and treatment record noted that the right-handed CI had two left shoulder dislocations (November 2004, and August 2006). MRI scan of the shoulder identified SLAP and Bankart lesions (fibrocartilage damage decreasing shoulder joint stability) and the CI underwent surgical repair of both lesions in September 2006. He continued with shoulder pain with overhead motions following rehabilitation and physical therapy. At the MEB exam, the CI reported inability to do overhead activities due to shoulder pain. The MEB physical exam noted pain-limited ROM with full strength and no upper extremity neurologic deficits. Profile restrictions included no pushups, FLAK vest, or lifting over 20 lbs.

At the VA Compensation and Pension (C&P) exam performed a month before separation, the CI reported shoulder pain and tenderness with keloid scar formation. Exam documented pain-limited ROM with “4 scars located in his left shoulder secondary to a SLAP lesion arthroscopic procedure done. He has a 0.5-cm size in diameter on those 4 scars with mild keloid formation and also tenderness to palpation on the scars on his left shoulder.”

The Board directed its attention to its rating recommendation based on the above evidence. All exams indicated pain-limited ROM warranting a 10% rating IAW VASRD §4.59. ROMs were well above the 90 degrees for forward flexion and abduction which would equate to the shoulder level which would rate at 20%. The Board did not adjudge that the subjective complaint of pain with overhead use equated to arm limitation at shoulder level. There was no post-surgical shoulder dislocation, loose movement, or shoulder deformity for any shoulder rating over 10%. 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 left shoulder condition, coded 5099-5203 for impairment of the shoulder joint (clavicle or scapula) with pain-limited motion.

The Board considered if the tender shoulder scars, as rated by the VA, were additionally unfitting and compensable as part of the unfitting chronic shoulder pain condition. The scars were not mentioned in the NARSUM or orthopedic addendum. Any contribution of the scars to limited shoulder motions was considered in the pain-limited motion 10% 5099-5203 rating of the shoulder. The Board considered if the profile restriction of no FLAK vest was attributable to the back pain, or shoulder pain (and/or shoulder scar) conditions, but there was no evidence specifying that tender scars interfered with duty performance. The CI, NARSUM, and PEB all focused on pain with overhead work, rather than pain with wear of military gear attributable to tender scars. After due deliberation in consideration of the evidence, the Board concluded that there was insufficient cause to recommend the tender shoulder scars as an additionally unfitting condition of the chronic shoulder pain condition. The Board concluded therefore that the scar condition could not be recommended for additional disability rating.


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 the USAPDA pain policy for rating the shoulder condition was operant in this case and the condition was adjudicated independently of that policy by this Board. In the matter of the low back condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication. In the matter of the chronic left shoulder pain condition, the Board unanimously recommends a disability rating of 10%, coded 5099-5203 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 his prior medical separation:

CONDITION
 VASRD CODE RATING
Chronic Radiating Low Back Pain... 5299-5237 10%
Chronic Left (Non-Dominant) Shoulder Pain... 5099-5203 10%
COMBINED
 20%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20131217, 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 , AR20150012733 (PD201302706)
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 20% 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                                                  XXXXXXXXXXXXXXXXXXXX
                                                      Deputy Assistant Secretary of the Army
                                                      (Review Boards)

CF:
( ) DoD PDBR
( ) DVA


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