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AF | PDBR | CY2014 | PD 2014 00470
Original file (PD 2014 00470.rtf) Auto-classification: Approved
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXX    CASE: PD-2014-00470
BRANCH OF SERVICE: ArmY  BOARD DATE: 20141112
SEPARATION DATE: 20060515


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty PV1/E-1 (14E/PATRIOT Fire Control Enhanced Operator and Maintainer) medically separated for low back pain. The low back pain 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 L3 profile and referred for a Medical Evaluation Board (MEB). The low back pain condition, characterized as “degenerative disc disease”, “lumbago”, “herniated lumbar disc L5/S1 right” and “lumbar radiculopathy”, were forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. No other conditions were submitted by the MEB. The Informal PEB adjudicated “chronic low back pain due to back injury with findings of a disc protrusion at L5/S1” as unfitting, rated at 10% with likely application of Veterans Affairs Schedule for Rating Disabilities (VASRD). The CI made no appeals and was medically separated.


CI CONTENTION: “Knee and back conditions.” [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 those conditions identified but not determined to be unfitting by the PEB when specifically requested by the CI. The rating for the unfitting low back condition is addressed below and, no additional conditions are within the DoDI 6040.44 defined purview of the Board. The requested knee condition was not identified by the MEB or PEB and thus is not 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 20060421
 VA - (3 Days Pre-Separation)
Condition
 Code Rating Condition Code Rating Exam
Chronic LBP w/ disc protrusion at L5/S1 5237 10% L5/S1 Right Central Disk Herniation/Extrusion w/ Deformity of the Right S1 Nerve Root 5243 10% 20060512
Other x 0 (Not in Scope)
 Other x 1
Combined: 10%
 Combined: 20%
* Derived from VA Rating Decision (VA RD ) dated 200 60622 (most proximate to date of separation)







ANALYSIS SUMMARY.

Low Back Pain Condition. The narrative summary (NARSUM) notes the CI injured his lower back in October 2005 while navigating an obstacle course. His condition was treated conservatively, but he continued to have the low back pain (LBP) pain, that radiated into his right lower extremity (RLE). An magnetic resonance imaging (MRI) of the lumbar spine dated 
6 January 2006, showed a lumbar disc herniation that impinged the right S1 nerve root. At the neurosurgical evaluation dated 20 March 2006 the CI reported LBP “shooting down” both legs and right leg weakness without sensory deficit or other neurological symptoms. The examination noted limited painful back flexion, no evidence of LE weakness and decreased sensation in the right lower extremity consistent with a dermatomal distribution. Straight leg raise testing was positive on the right. Disc surgery was discussed but the CI declined.

At the MEB examination dated 23 March 2006 (approximately 2 months prior to separation), the CI reported LBP. The MEB physical exam noted range-of-motion (ROM) of thoracolumbar (TL) flexion of 60 degrees, 60 degrees and 60 degrees (normal 75 degrees) and combined ROM noted of 145 degrees (normal 235 degrees) with “ROM diminished by pain” and the remainder of the findings were noted to be the same as the neurosurgical evaluation. Physical therapy TL ROM measured on 6 April 2006 for the MEB was 47 degrees, 47 degrees and 52 degrees, with combined ROM of 215 degrees, with painful ROM noted.

During the VA Compensation and Pension (C&P) examination (performed 3 days prior to separation), the CI reported chronic LBP. The VA examiner noted that the CI had normal gait and posture and that “his physical limitation is minimal today.” Lumbar spine ROM was flexion of 70 degrees and combined ROM of 195 degrees. The examiner noted “no abnormal curvature” of the spine and “no radiculopathy extending to both lower extremities with flexion, extension of lumbar spine and/or with leg raises”.

The Board directs attention to its rating recommendation based on the above evidence. The PEB rated the low back condition at 10%, coded 5237 (lumbosacral strain) and the VA rated it 10%, coded 5243 (intervertebral disc syndrome). The Board noted that the physical therapy ROM was significantly less than the ROM noted at the later MEB and C&P examinations. The MEB flexion ROM was noted as 60 degrees, which would meet the 20% rating based on current VASRD spine rating criteria, but the MEB examiner indicated a normal for flexion of 75 degrees, 15 degrees less than the VA normal of 90 degrees. Therefore, the Board consensus was that there was some uncertainty whether this evidence represented TL flexion 15 degrees less than normal (75 degrees) or 60 degrees. The Board noted that all other evidence at the MEB and C&P examinations, including combined ROM, absence of muscle spasm and flexion of 70 degrees at the C&P examination supported the 10% rating. However, based upon resolving reasonable doubt in favor of the CI, IAW VASRD §4.3 (reasonable doubt), the Board agreed that the physical therapy and MEB examinations provided support for the 20% rating based upon ROM of TL flexion “greater than 30 degrees but not greater than 60 degrees”. Thus, IAW VASRD §4.7 (higher of two evaluations) the Board agreed that the 20% rating was applicable. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 20% for the chronic LBP condition, coded 5243.

The Board also considered if additional disability rating was justified for peripheral nerve impairment due to radiculopathy. The CI initially reported symptoms of back pain that radiated to the LE. At the MEB examination decreased sensation was noted in the RLE but at the C&P examination the examiner noted no radiculopathy involving either LE. Any radiating pain from the back condition is subsumed under the general spine rating criteria, which specifically states “with or without symptoms such as pain (whether or not it radiates)…” Therefore the critical decision is whether or not there was a significant sensory deficit which would impact military occupation specific activities. There is no evidence in this case that the decreased sensation could be described as functionally impairing, and the pre-separation C&P examination provides support that the sensory disturbance had improved, possibly resolved. The Board concluded therefore that additional disability rating due to peripheral nerve impairment could not be 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 chronic low back pain condition, the Board unanimously recommends a disability rating of 20%, coded 5243 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:

UNFITTING CONDITION VASRD CODE RATING
Chronic Low Back Pain 5243 20%
COMBINED 20%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20140116, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record






                          
XXXXXXXXXXXXXXX
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 XXXXXXXXXXXXXXX, AR20150004347 (PD201400470)
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                                                  XXXXXXXXXXXXXXX
                                                      Deputy Assistant Secretary of the Army
                                                      (Review Boards)

CF:
( ) DoD PDBR
( ) DVA

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