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AF | PDBR | CY2013 | PD2013 00040
Original file (PD2013 00040.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:    CASE: PD1300040
BRANCH OF SERVICE: army  BOARD DATE: 20130503
SEPARATION DATE: 20060402


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SSGT/E-6 (19K/M1 Armor Crewmember) medically separated for chronic low back pain (LBP). He reported LBP after being thrown from a Humvee in Iraq in 2003. However, a pre-deployment physical documented a history of LBP. Numerous specialty clinics were consulted, but no surgery was indicated. 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 L3 profile and referred for a Medical Evaluation Board (MEB). The LBP condition, characterized as “chronic low back pain secondary to lumbar disc degeneration,” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. No other conditions were submitted by the MEB. The PEB adjudicated “chronic low back pain associated with lumbar disc degeneration L4-L5, without neurologic abnormality” as unfitting, rated 10% with likely application of the Veterans’ Administration Schedule for Rating Disabilities (VASRD). The CI made no appeals, and was medically separated with a 10% disability rating.


CI CONTENTION: “I believe that I should have been medically retired as I had over 17 years of active duty service at the time of my medical board. I have since been found to be 40% combined disabled by the VA for conditions related to my back (the reason I was medically discharged).”


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 those conditions identified but not determined to be unfitting by the PEB when specifically requested by the CI. Ratings for unfitting conditions will be reviewed in all cases. The Service rated, unfitting LBP condition meets the criteria prescribed in DoDI 6040.44 for Board purview. Any conditions or contention not requested in his application, or otherwise outside the Board’s defined scope of review, remain eligible for future consideration by the Army Board for Correction of Military Records.


 RATING COMPARISON :

Service IPEB – Dated 20060224
 VA – (8 mos. Pre-Separation)
Condition
 Code Rating Condition Code Rating Exam
Chronic Low Back Pain, associated with Lumbar Disc Degeneration L4-L5, without Neurologic Abnormality 5299-5237 10% Disc Disease, Lumbar Spine 5299-5243 10% 20050803
No Additional MEB/PEB Entries
 Other x 7 20050803
Combined: 10%
 Combined: 10%
Derived from VA Ratin g Decision (VARD) dated 200 60419 ( most proximate to date of separation [DOS ] )



ANALYSIS SUMMARY:

Low Back Pain. The CI has a long history of problems with LBP. In February 2003, he had LBP after working on tanks the previous day. In November 2003, he developed LBP after carrying some injured soldiers. Magnetic resonance imaging (MRI) in April 2005 showed a broad-based disc bulge at L4-L5, and mild foraminal stenosis. Many different treatment measures were tried, but his LBP persisted and an MEB was initiated. The MEB physical examination was in August 2005. The CI was alert and oriented. Gait, stance, and coordination were normal. The lumbar spine was normal in appearance and nontender to palpation. Muscle strength was normal, and no muscle spasm was noted. Straight leg raise (SLR) was negative. Neurological exam was normal. Lumbar range-of-motion (ROM) was measured and is summarized in the chart below.

The CI was seen by Orthopedics on 6 January 2006. A physical examination revealed some tenderness to palpation (TTP) on the left. The CI was able to heel, toe, and heel-toe walk. Seated SLR was negative. Muscle strength was normal, and deep tendon reflexes were symmetric. The two ROM evaluations which were weighed by the Board, are summarized in the chart below.

Thoracolumbar ROM
 MEB ~ 8 mos . Pre-Sep
(200 50803 )
 Ortho ~ 3 mos. Pre-Sep
(200 60106 )
Flexion (90 ⁰ is n ormal)
 85 ⁰ 70⁰
Combined (240 ⁰ is n ormal )
 210⁰ 170⁰
VASRD §4.71a Rating
 10% 10%

The Board carefully reviewed all evidentiary information available, and directs attention to its rating recommendation based on the above evidence. The Army PEB and the VA chose different coding options for the back pain condition, but both assigned a rating of 10%. IAW VASRD §4.71a , a 10% r ating is warranted for thoracolumbar flexion greater that 60 degrees but not greater than 85 degrees ; or combined thoracolumbar ROM greater than 120 degrees but not greater than 235 degrees. Therefore, the Board determined that a separation disability rating of 10% was appropriate. The Board tried to find a path to a rating higher than 10%, using other codes which could be applied to the LBP condition. The other VASRD codes that were considered did not result in a higher rating, since the service treatment record (STR) did not show sufficient evidence of a disabling lumbar spine condition which would justify a rating higher than 10%. The Board also considered the matter of peripheral neuropathy. After reviewing all the information in the STR, there was insufficient evidence of a clinically significant neuropathy that interfered with satisfactory performance of military duties. Therefore, there was no unfitting radiculopathy present at the time of separation. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board found insufficient cause to recommend a change in the PEB adjudication 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. 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 recharacterization of the CI’s disability and separation determination, as follows:

UNFITTING CONDITION
 VASRD CODE RATING
Chronic low back pain, with lumbar disc degeneration L4-L5 5299-5237 10%
COMBINED
 10%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20130125, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record





         Physical Disability Board of Review


 SFMR-RB                                                                         


MEMORANDUM FOR Commander, US Army Physical Disability Agency
(TAPD-ZB ),

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation for AR20130010296 (PD201300040)

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                                                 
                                                      (Army Review Boards)

CF:
( ) DoD PDBR
( ) DVA

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