Search Decisions

Decision Text

AF | PDBR | CY2013 | PD-2013-02752
Original file (PD-2013-02752.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXXXX       CASE: PD-2013-02752
BRANCH OF SERVICE: Army  BOARD DATE: 20150605
SEPARATION DATE: 20070626


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated National Guard E-5 (Petroleum Laboratory Specialist) medically separated for a chronic back pain condition. The condition 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 P3L3 profile and referred for a Medical Evaluation Board (MEB). The chronic low back pain” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. The MEB also identified and forwarded an obstructive sleep apnea (OSA) condition for PEB adjudication. The Informal PEB adjudicated chronic back pain as unfitting, rated 0%, with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD). The OSA condition was determined to be not unfitting and not rated. The CI made no appeals and was medically separated.


CI CONTENTION: VA Disability Rating is 60% while Military Disability Rating is 0%.[sic]


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 20070510
VA* - (~7 Mos. Post-Separation)
Condition
Code Rating Condition Code Rating Exam
Chronic Back Pain 5299-5242 0% Herniated Nucleus Pulposus, L5-S1 5243 10% 20080206
Obstructive Sleep Apnea Not Unfitting Obstructive Sleep Apnea 6847 50% 20080206
Other x 0 (Not In Scope)
Other x 2
RATING: 0%
RATING: 60%
* Derived from VA Rating Decision (VA RD ) dated 20080221 (most proximate to date of separation ( DOS ) ) .




ANALYSIS SUMMARY:

Chronic Back Pain. The CI reported a history of low back pain (LBP) on 1 September 2004. He was treated conservatively with medications and duty restrictions. He then presented with a 2-day history of LBP following a mission and was again treated conservatively. The range-of-motion (ROM) was normal as it was at a later visit on 1 November 2005. A magnetic resonance image on 26 March 2006 showed a herniated disc at L4-5 and L5-S1 with the latter impinging the nerve root on the right. A follow-up appointment on 30 March 2006 in physical medicine showed a normal neurological examination, but with limited ROM especially with maneuvers on the right. He was treated with epidural steroid injections (ESI, injections near the nerve root) and physical therapy with benefit. At the 22 June 2006 physical medicine appointment, he had considerable resolution of his LBP and it was thought that the radicular irritation had resolved. The neurological examination remained normal. At a primary care appointment on 14 December 2006, the neurological examination was normal as well. The narrative summary (NARSUM) was dated 8 March 2007. The CI reported occasional LBP with radiation into the right buttock, but also that he was able to control the pain by limiting his activity. He took no medications for his LBP. On examination, his gait, toe and heel walk, and neurological examination were normal. There was neither spasm nor tenderness on palpation. The ROM was pain free and exceeded VA normal values. At the MEB examination 4 days later and just over 3 months prior to separation, the CI reported recurring back problems. The examiner noted a full ROM, normal neurological examination, and negative provocative testing for nerve root irritation.

At the VA Compensation and Pension (C&P) examination was performed 8 months after separation, the CI reported unlimited walking and no pain with daily activities. His gait, neurological examination, and heel and toe walk were normal. Motion was non painful. His pain was referred along the right S1 nerve root. The ROM was reduced in flexion at 80 degrees, but otherwise normal. DeLuca criteria were negative with repetition.

The Board directed its attention to its rating recommendation based on the above evidence. The PEB rated the back at 0% using the analogous code 5299-5242 (degenerative arthritis of the spine) while the VA rated the back at 10%, relying on the C&P examination ROM measurements, and using the code 5243 (intervertebral disc syndrome). The Board noted that while the VA examination supports a 10% rating, the MEB examination is as complete and more proximate to separation. It is therefore assigned a higher probative value. 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 back condition. While the CI reported radicular symptoms on some examinations, the neurological examination was consistently normal. The Board concluded therefore that an unfitting radiculopathy was not present at separation.

Contended PEB Conditions. The Board’s main charge is to assess the fairness of the PEB’s determination that OSA was not unfitting. The Board’s threshold for countering fitness determinations requires a preponderance of evidence, but remains adherent to the DoDI 6040.44 “fair and equitable” standard. The OSA was profiled and judged to fail retention standards. However, it was not implicated in the commander’s statement and the fitness reports prepared for the CI prior to diagnosis and treatment were good and indicated that he met duty requirements. The OSA was reviewed and considered by the Board. There was no performance based evidence from the record that it significantly interfered with satisfactory duty performance. 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 it and so no additional disability rating is recommended.


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 back condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication. In the matter of the contended OSA conditions, the Board unanimously recommends no change from the PEB determinations as not unfitting. 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 20131220, 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 XXXXXXXXXXXXXXXXXXXX , AR20150012745 (PD201302752)


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


Similar Decisions

  • AF | PDBR | CY2012 | PD-2012-01342

    Original file (PD-2012-01342.rtf) Auto-classification: Denied

    Lower extremity sensation, strength and reflexes were normal.According to subsequent VA C&P examinations, the CI underwent back surgery in July 2004 without improvement in his back pain. Except for the VA C&P examination 2 months after separation, examinations in the months during 2003 prior to separation documented back flexion that exceeded 30 degrees and ranged from 45 degrees to “full”ROM and therefore did not support a rating higher than the 20% adjudicated by the PEB or the VA. ...

  • AF | PDBR | CY2011 | PD2011-00042

    Original file (PD2011-00042.docx) Auto-classification: Approved

    No post-separation VA outpatient notes were included in the record; however a VA rating decision 23 months post-separation showed no changes in the VA rating (20%) for the CI’s back condition. The Board deliberated concerning the fitness of OSA and considered the duty restrictions at the time of the commander’s statement and profile were prior to a sufficient period of treatment with CPAP; however, by the time of separation there was no evidence of ongoing excessive daytime somnolence or...

  • AF | PDBR | CY2014 | PD-2014-01122

    Original file (PD-2014-01122.rtf) Auto-classification: Denied

    The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of theVASRD standards to the unfitting medical condition at the time of separation. The thoracolumbar spine exam showed moderate spasm and flattening of the lower lumbar spine. From 1 to 10 (10 being the worst pain) the pain level is at 6.

  • AF | PDBR | CY2014 | PD-2014-02147

    Original file (PD-2014-02147.rtf) Auto-classification: Denied

    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 range-of-motion (ROM) and neurological examination were normal. The radiculopathy condition was reviewed and considered by the Board.

  • AF | PDBR | CY2013 | PD-2013-02636

    Original file (PD-2013-02636.rtf) Auto-classification: Denied

    Pre-Separation) ConditionCodeRatingConditionCodeRatingExam Chronic Low Back Pain5299-523710%Degenerative Disc Disease, Moderate in Nature, L5-S-1 and Mild at L4-5 with Facet Spondylosis Lumbar Spine5242-501010%20080502Obstructive Sleep ApneaNot UnfittingSleep Apnea6847NSCSTRTinnitusNot UnfittingTinnitus Right Ear626010%STROther x 3 (Not In Scope)Other x 5 RATING: 10%RATING: 20% *Derived from VA Rating Decision (VARD)dated 20080613(most proximate to date of separation [DOS]). An MRI of the...

  • AF | PDBR | CY2012 | PD2012-00099

    Original file (PD2012-00099.docx) Auto-classification: Approved

    At the MEB NARSUM evaluation, performed on 5 September 2002, the CI reported low back pain and radiation of pain down left leg. In the matter of the sleep apnea condition, the Board unanimously recommends a disability rating of 50%, coded 6847 IAW VASRD §4.97. Providing a correction to the individual’s separation document showing that the individual was separated by reason of permanent disability retirement effective the date of the original medical separation for disability with severance pay.

  • AF | PDBR | CY2013 | PD2013 00860

    Original file (PD2013 00860.rtf) Auto-classification: Denied

    SEPARATION DATE: 20050526 The Board’s authority as defined in DoDI 6044.40; however, resides in evaluating the fairness of DES fitness determinations and rating decisions for disability at the time of separation. A pain management note dated 5 April 2005 documented that the CI received good pain relief from the RFA for about 6 months and then underwent repeat RFA with another 6 months of pain relief.

  • AF | PDBR | CY2014 | PD-2014-02201

    Original file (PD-2014-02201.rtf) Auto-classification: Denied

    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. RATING COMPARISON : ReconsiderationIPEB – dated 20070427VA* – (~34months Post-Separation) ConditionCodeRatingConditionCodeRatingExam Chronic Lumbar Strain524320%Chronic Lumbar Strain523710%20100716Radiculopathy, Left...

  • AF | PDBR | CY2013 | PD2013 00145

    Original file (PD2013 00145.rtf) Auto-classification: Denied

    The back condition, characterized as “chronic low back pain with s/p lumbar fusion with osteoarthritis” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. The Board also acknowledges the CI’s contention for ratings of his sleep apnea condition which was determined by the MEB to meet retention standards. Board members finally debated the application of VASRD §4.45in this case, which allows for the next higher rating if evidence of additional functional loss after repetitive...

  • AF | PDBR | CY2012 | PD-2012-00410

    Original file (PD-2012-00410.pdf) Auto-classification: Denied

    Bilateral Leg Pain Condition. On examination, he was noted to have normal ROM and that there was no tenderness. RECOMMENDATION: The Board, therefore, recommends that there be no recharacterization of the CI’s disability and separation determination, as follows: UNFITTING CONDITION VASRD CODE RATING 5299‐5237 5099‐5022 5299‐5276 COMBINED 10% 10% ‐‐‐ 20% MEMORANDUM FOR Commander, US Army Physical Disability Agency 5 PD12‐00410 Low Back Pain Bilateral Leg Pain Bilateral Pes Planus The...