Search Decisions

Decision Text

AF | PDBR | CY2013 | PD2013 01221
Original file (PD2013 01221.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX         CASE: PD1301221
BRANCH OF SERVICE: Army  BOARD DATE: 20140415
SEPARATION DATE: 20040421


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (52D/Generator Operator) medically separated for a chronic low back pain (LBP) and bilateral shoulder pain condition. His shoulder pain persisted despite conservative treatment and neither condition (back or shoulder), could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards. He was issued a permanent U3L4 profile and referred for a Medical Evaluation Board (MEB). The back and bilateral shoulder condition, characterized as “chronic LBP with Degenerative Disc Disease (DDD) L4/L5 laminectomy and bilateral acromioclavicular (AC) joint arthrodesis (degenerative change) with subacromial impingement syndrome,” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. The MEB also identified and forwarded two other conditions. The Informal PEB adjudicated the LBP w/DDD and bilateral shoulder conditions as unfitting, rated 10% and 10% respectively. The CI made no appeals and was medically separated.


CI CONTENTION: “Worsening of rated conditions in shoulders and spine. Osteoarthritis in addition.”


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. The rating for the unfitting back and bilateral shoulder condition is addressed below and, no additional conditions are within the DoDI 6040.44 defined purview of the Board. Any conditions or contention not requested in this application, or otherwise outside the Board’s defined scope of review, remain eligible for future consideration by the Board for Correction of Military Records.


 RATING COMPARISON :

Service IPEB – Dated 20040107
 VA - (3 Mos. Pre-Separation)
Condition
 Code Rating Condition Code Rating Exam
Chronic LBP w/DDD 5243 10% Postoperative DJD w/Spondylosis, Thoracolumbar Spine 5243 10% 20040123
Bilateral Shoulder Pain 5003 10% DJD Bilateral Shoulders and Cervical Spondylosis 5003 10% 20040123
Multiple Joint Pain Not Unfitting NSC
Seborrheic Dermatitis Not Unfitting NSC
No Additional MEB/PEB Entries
 Other x 20% 20040123
Combined: 20%
 Combined: 20%
Derived from VA Rating Decision (VA RD ) dated 200 40616 most proximate to date of separation [ DOS ] ).


ANALYSIS SUMMARY: The Board acknowledges the CI’s information regarding the significant impairment with which his service-connected condition continues to burden him; but, must emphasize that the Disability Evaluation System has neither the role nor the authority to compensate members for anticipated future severity or potential complications of conditions resulting in medical separation. That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws. Post-separation evidence is probative to the Board’s recommendations only to the extent that it reasonably reflects the disability at the time of separation. The Board’s role is confined to the review of medical records and all evidence at hand to assess the fairness of PEB rating determinations, compared to the VA Schedule for Rating Disabilities (VASRD) standards, based on ratable severity at the time of separation.
Chronic Low Back Pain w/DDD Condition. The CI had no history of direct trauma to his low back. Initially, he injured his low back while loading a military vehicle in September 2001. Originally diagnosed with back pain due to muscle spasms, the pain worsened and extended into his left leg within 4 months. Despite aggressive physical therapy (PT), acupuncture, manipulation, injections and medication his symptoms remained. Radiologic tests revealed DDD of the lumbosacral spine with a large disc protrusion at L4-L5 level causing “moderate to severe” central canal stenosis (narrowing of the spinal canal). He underwent an L4-L5 discectomy without fusion on 10 May 2002 with a slow, but significant improvement in his back-associated leg pain post-operatively for 15 months. The service treatment record indicated a return of lower extremity weakness (left > right) associated with constant LBP on 14 August 2003. Despite repeat radiology results that revealed “resolution of spinal stenosis at the L4-L5 level,” the CI once again received spinal injections and was referred to a medical board. The MEB narrative summary (NARSUM) examination performed 5 months prior to separation summarized the CI’s history and treatment of his LBP without additional subjective complaints. The examination revealed tenderness to the lumbar spine and both hips. Reflexes were minimally decreased on the left LE. Muscle spasm was not present and straight leg raise (SLR) was negative. Strength, sensory and motor activity was normal. There was no comment in regards to guarding. At the VA Compensation and Pension (C&P) examination performed 3 months prior to separation, the CI indicated that his back condition “does not interfere with his ordinary lifting or carrying or activities of daily living.” Under “review of systems” the examiner stated, “In general, [the CI] can sustain heavy physical activities without immediate distress.” The examination revealed a normal gait. The lumbosacral spine was absent spasm, atrophy or painful motion. Sensory perception, reflexes and SLR were normal. Range-of-motion (ROM) was mildly limited without pain or further decrement with regards to weakness, lack of endurance, fatigue or incoordination. His diagnosis was post lumbar surgery with mild limited ROM. There was no comment on his functional ability. The goniometric ROM evaluations in evidence which the Board weighed in arriving at its rating recommendation, with documentation of additional ratable criteria, are summarized in the chart below.

DOS 20040421
Thoracolumbar ROM
(Degrees)
 MEB (PT)~8 Mo. Pre-Sep
(20030827)
VA C&P ~ 3 Mo. Pre-Sep
(20040123)
Flexion (90 Normal)
 90 85
Extension (30)
 20 25
R Lat Flexion (30)
 35 40
L Lat Flexion (30)
 35 40
R Rotation (30)
 40 35
L Rotation (30)
 40 35
Combined (240)
 260 260
Comment
 tenderness -
§4.71a Rating
 10% 10%

The Board directs attenti on to its rating recommendation based on the above evidence . Both the PEB and VA applied the clinically compatible code 5243 (intervertebral disc syndrome) and arrived at the same 10% rating under the VASRD §4.71a general rating formula for the spine accurate for the respective ROM in evidence as well as tenderness without resulting in abnormal gait or spinal contour . There was no documentation for incapacitating episodes which would achieve a higher rating under 5243. All members agreed that there was no separately ratable neuropathy for disability, since no functional impairment linked to fitness was in evidence. Additionally, the specific lower extremity pain component is subsumed under the general spine rating as specified in §4.71a. Since no evidence of functional impairment existed, the Board cannot support a recommendation for additional disability 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 chronic LBP with DDD condition.

Bilateral Shoulder Condition. There was a paucity of separate evidence in regards to the CI’s bilateral shoulder condition. Absent direct trauma, the CI developed non-radicular pain in both shoulders in August 2000. His painful condition persisted despite rest, PT and local injections. The MEB NARSUM (shoulder) examination performed on 11 September 2003, 7 months prior to separation, summarized the CI’s history and treatment of his shoulder condition without additional subjective complaints. The physical examination revealed tenderness over the front and side of each shoulder. Impingement signs were present bilaterally. Instability or laxity was not present in either shoulder. X-rays revealed bilateral AC joints with degenerative changes. The diagnosis was bilateral AC joint arthrodesis and subacromial impingement syndrome. His functional restrictions included not raising or crossing his arms due to the onset of severe pain. “Any physical exertion caused pain.” At the VA C&P examination, performed 3 months prior to separation, there was full ROM at both shoulders with no abnormalities found. Sensory perception and strength in the UE was normal. No diagnosis was rendered.

The Board directs attention to its rating recommendation based on the above evidence. The normal ROM and examination, as detailed by the VA 3 months prior to separation, does not support any minimum ratable joint code. The only ratable finding in this case was the radiographic arthrosis in the combined AC joints. Board members agreed that each shoulder (AC joint) was not independently unfitting. The PEB’s 10% rating of 5003 (degenerative arthritis) thus provided the highest achievable rating under VASRD §4.71a. 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 of the bilateral shoulder 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. In the matter of the bilateral shoulder pain 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.


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20130909, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record




XXXXXXXXXXXXXXXXXX
President
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 XXXXXXXXXXXXXXXXXX , AR20140019507 (PD201301221)

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

Similar Decisions

  • AF | PDBR | CY2013 | PD-2013-01816

    Original file (PD-2013-01816.rtf) Auto-classification: Denied

    The commander’s statement noted that the CI’s back condition precluded him from performing critical field tasks, his condition further interfered with his MOS duties and adversely affected his unit’s readiness.The MEB narrative summary (NARSUM) exam approximately 5 monthsprior to separation documented that the CI was seen in the ER on 3 October 2003 and given intravenous morphine for acute LBP and that he still had occasional moderate LBP. RECOMMENDATION : The Board, therefore, recommends...

  • AF | PDBR | CY2013 | PD-2013-01840

    Original file (PD-2013-01840.rtf) Auto-classification: Denied

    invalid font number 31502 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 low back pain condition, the Board unanimously recommends a disability...

  • AF | PDBR | CY2013 | PD-2013-00707

    Original file (PD-2013-00707.rtf) Auto-classification: Approved

    The Informal PEB adjudicated “chronic neck pain due to DDD,”“chronic LBP due to DDD” and “chronic pain of right shoulder due to acromioclavicular joint separation” as unfitting, rating them at 10%, 10% and 0% respectively, citing the US Army Physical Disability Agency (USAPDA) pain policy for the right shoulder condition.The CI made no appeals and was medically separated Mental Health Review .The CI was deployed to Iraq from April to August 2003.On 1 November 2003 (9 months prior to...

  • AF | PDBR | CY2012 | PD 2012 00887

    Original file (PD 2012 00887.txt) Auto-classification: Approved

    Post-Separation) – All Effective Date 20060409 Condition Code Rating Condition Code Rating Exam Chronic LBP 5299-5242 0% DDD Lumbosacral Spine 5243 40% 20070122 Chronic Bilateral Knee Pain 5099-5003 0% S/P Arthroscopic Repair of Medial Meniscal Tear Right Knee w/ Traumatic DJD 5260-5010 10% 20070124 Left Knee Injury 5260 NSC* 20070122 No Additional MEB/PEB Entries Other x 13 20070122 Combined: 0% Combined: 70% Derived from VA Rating Decision 20070308 (most proximate from the date of...

  • AF | PDBR | CY2014 | PD-2014-01049

    Original file (PD-2014-01049.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. 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...

  • AF | PDBR | CY2013 | PD-2013-02000

    Original file (PD-2013-02000.rtf) Auto-classification: Approved

    SEPARATION DATE: 20050622 The Board considered that the MEB exam, although closest to the date of separation, did not align with the more severe disability picture and limited ROMs noted in the service treatment record through multiple treatment episodes. The PT and chiropractic exams, coupled with the continued limited motion noted on the DD Form 2808 closer to separation, provided reasonable doubt of greater ROM limitation than that documented at the NARSUM.

  • AF | PDBR | CY2013 | PD-2013-02308

    Original file (PD-2013-02308.rtf) Auto-classification: Denied

    He rated his pain at 4/10. Deluca criteria§4.71a Rating10%* (PEB 10%)10% (VA 10%) invalid font number 31502 *IAW VASRD §4.59, Painful motion invalid font number 31502 The Board directed attention to its rating recommendation based on the above evidence.The PEB coded the chronic LBP secondary to L5-S1 HNP without neurologic deficit condition 5243 (Intervertebral Disc Syndrome) and rated at 10%. RECOMMENDATION : The Board, therefore, recommends that there be no re-characterization of the...

  • AF | PDBR | CY2013 | PD-2013-01815

    Original file (PD-2013-01815.rtf) Auto-classification: Denied

    The VA physical examination revealed normal gait and posture. The Board additionally considered if the symptomatic lower extremity radiculopathy warranted an additional disability rating; but, members agreed that the requisite link of the neuropathy symptoms with functional impairment was not in evidence. RECOMMENDATION : The Board, therefore, recommends that there be no recharacterization of the CI’s disability and separation determination.

  • AF | PDBR | CY2013 | PD-2013-01856

    Original file (PD-2013-01856.rtf) Auto-classification: Denied

    The condition was characterized by the MEB as “chronic low back pain with lumbar degenerative disc disease” and it was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. The PEB adjudicated “chronic low back pain”…with “no neurological deficits “as unfitting, rated 10%citing criteria of the VA Schedule for Rating Disabilities (VASRD).The remaining condition was determined to be “medically acceptable.” The CI made no appeals and was medically separated. Contended Pain and...

  • AF | PDBR | CY2014 | PD-2014-00747

    Original file (PD-2014-00747.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 theVeterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation. The VA rated the condition analogously to code 5242 at 10%, citing the range-of-motion (ROM) measurements done at the C&P examination.The limitation of motion at the MEB examination supported the 20% rating adjudicated...