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AF | PDBR | CY2014 | PD-2014-00919

Original file (PD-2014-00919.rtf) Auto-classification: Denied

RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX CASE: PD-2014-00919
BRANCH OF SERVICE: Army BOARD DATE: 20150113

SEPARATION DATE: 20080611

SUMMARY OF CASE : Data extracted from t he available evidence of record reflects that this covered individual (CI) was an activated National Guard E- 1 ( Ammunition Specialist ) medically separated for a back condition and a hip condition . The conditions could not be adequately rehabilitated to meet the requirements of her Military Occupational Specialty or physical fitness standards. She was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB). The back and hip conditions, characterized as “ chronic low back pain; lumbar degenerative disc disease; and disc herniation ” and “ right hip pain ,” were forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. No other conditions were submitted by the MEB. The Informal PEB (IPEB) adjudicated the back condition and the hip condition as unfitting, rated 10% and 10% respectively, with likely application of the VA Schedule for Rating Disabilities (VASRD). The CI made no appeals and was medically separated.

CI CONTENTION: “I do not feel that 20% is a proper rating. I was 18 when I Injured in 2007 since this time I have been unable to work in my dream field. I am unable to do much of any physical activity. I have difficulty standing for more than 5-10 mins w/out pain or discomfort. I also can not sit in the same position for more than 30 mins without pain. I can’t run and can only walk shorter distances. I’m 24 years old and can’t play with my children, go on a trip or watch TV w/out a painful reminder. My hip and back impact my life everyday and have robbed me of the things I enjoy. I have also had difficulty working in an office due to my back and miss work due to back pain.”

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 Veterans Affairs Schedule for Rating Disabilities (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 :

Service IPEB – Dated 20080509	VA - based on Service Treatment Records (STR)
Condition	Code	Rating	Condition	Code	Rating	Exam
Lumbar Degenerative Disc Disease with an L5-S1 Disc Protrusion	5299-5242	10%	Degenerative Disc Disease, Lumbar Spine at L5-S1	5237	0%	STR
Right Hip Pain…	5099-5003	10%	Right Trochanteric Bursitis with Effusion	5251	0%	STR
Other x 0 (Not in Scope)	Other x 0
Rating: 20%	Combined: 0%

Derived from VA Rating Decision (VA RD ) dated 200 90312 .

ANALYSIS SUMMARY:

Hip Condition. The narrative summary (NARSUM) noted the CI reported right hip pain on 25 October 2007. The CI described an injury in September 2007 when she fell on her right side on an obstacle course. Pelvis X-rays and bone scan were normal and the CI was treated with anti-inflammatory medication and placed on profile. She had persistent symptoms despite treatment, including physical therapy (PT). Orthopedic evaluation on 14 January 2008 noted tenderness to palpation (TTP) and full range-of-motion (ROM) of the hip. Magnetic resonance imaging (MRI) reportedly showed slight effusion in both hip joints, worse on the right and the CI was given a steroid injection for bursitis. At a follow-up orthopedic evaluation the hip was improved with full ROM, but pain persisted in the back. The orthopedic specialist ordered an MRI of the lumbar spine for the back pain, discussed further below. Despite treatment with multiple medications, physical therapy, and steroid injections, the right hip pain continued.

At the MEB examination on 30 April 2008, approximately a month prior to separation, the CI reported mild right hip pain rated 2-3/10, with exacerbations to 6/10. The MEB physical exam noted normal movement of the lower extremities (LE). There was TTP of the hip with decreased ROM and pain with internal rotation and abduction. There was normal LE strength, sensation, and reflexes. PT ROM for the MEB was 80 degrees flexion after repetition (normal 125 degrees); abduction of 25 degrees after repetition (normal 45 degrees) and normal extension, with no change with repetition, with painful motion noted.

The CI did not report for an initial VA Compensation and Pension (C&P) examination on 9 March 2009. There are missing pages of the initial VA C&P on 22 August 2009, approximately 14 months after separation. The available pages noted that the CI’s hip pain was stable with good response to anti-inflammatory medication. The VARD dated 14 September 2009 cited the remainder of the C&P exam findings. There was no swelling, tenderness or laxity of the hip. ROM was flexion of 100 degrees, with normal extension and abduction noted, and the legs were able to be crossed. There was objective evidence of painful motion with no change of ROM with repetition. Hip X-rays were reported as “within normal.”

The Board directed attention to its rating recommendation based on the above evidence. The PEB rated the hip condition 10%, coded 5099-5003 for “periarticular pathology” and noted that IAW VASRD §4.59 painful motion warrants a minimum 10% rating. The VA initially rated the hip condition 0%, coded 5251 (limited thigh extension), but the VARD on 14 September 2009 increased the rating to 10%. The Board agreed that the evidence in record supports a 10% rating for the right hip condition based upon painful motion, without compensable loss of ROM with multiple codes- 5003 ( degenerative arthritis), 5251, 5252 (limited thigh flexion), or 5253 (thigh impairment). The Board reviewed to see if a higher evaluation was achievable but there was no evidence of ROM meeting threshold compensable criteria for thigh extension or flexion, or for thigh impairment due to loss of abduction, external rotation, or adduction, and there was no evidence of femur impairment, hip ankylosis or flail joint. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt) and §4.59, the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the right hip condition.

Back Condition. The NARSUM notes that without specific injury, the CI reported gradual onset of low back pain (LBP) in December 2007 while she was on profile for right hip pain. As noted above, the back pain was first thought to be related to the hip pain but the CI was evaluated for the back pain when it continued without change following steroid injection of the right hip. Thoracolumbar spine X-rays on 26 October 2006 noted only minimal thoracic spine curvature. Lumbar spine MRI on 21 February 2008 showed a broad based disc bulge at L5-S1 not causing spinal or nerve exit stenosis or nerve root impingement. According to the NARSUM the CI did not have PT for the back pain, but she had been treated with multiple medications including anti-inflammatory medication, pain medications, and courses of oral steroids for the hip and back pain, without change in her symptoms.

At the MEB examination on 30 April 2008, approximately a month prior to separation, the CI reported constant daily back pain, rated 5/10, with exacerbations. She denied muscle spasm, stiffness, radicular symptoms, numbness, or neurological problems. The MEB physical exam noted normal movement of the lower extremities. There was TTP of the lumbar spine, no muscle spasm or TTP of the sacroiliac joint. The CI could walk on heels, toes, and perform tandem gait without difficulty. Straight leg testing was negative bilaterally. Thoracolumbar ROM was intact except for decreased lateral rotation and side bending to the right. Strength, sensation and reflexes of the LE were normal. PT ROM for the MEB was normal except for 5 degrees loss of left lateral rotation. April 2008 showed flexion of 95 degrees (normal 90 degrees) and combined ROM of 235 degrees, without loss of ROM with repetition. The therapist noted the CI denied any radiating pain.

The CI did not report for a VA C&P examination on 9 March 2009. The initial VA C&P on 22 August 2009, approximately 14 months after separation, noted that the CI’s LBP was stable with good response to anti-inflammatory medication. The 14 September 2009 VARD cited the remainder of the C&P exam findings. There was one day of incapacitation in the previous 12 months. The CI reported constant back pain. On examination there was a normal gait, without guarding, muscle spasm, or tenderness. ROM was flexion of 80 degrees with combined ROM of 180 degrees, with no pain on motion. Strength and sensation was normal. Back X-rays were normal, but degenerative disc disease on the February 2008 MRI was noted.

The Board directed attention to its rating recommendation based on the above evidence. The PEB rated the back condition 10%, coded 5299-5242 (analogous to degenerative arthritis of the spine) and the VA initially rated it 0%, coded 5237 (lumbosacral strain), and the later VARD increased it to 10% effective the day after separation. The Board agreed that the evidence in record supports a 10% rating at the time of separation based upon limited combined ROM and painful motion IAW the VASRD General Formula for R ating the S pine in effect at the time of separation , based on “ combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235” ; and did not meet th e 20% rating criteria , specified as “ forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or, the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, muscle spasm or guarding severe enough to result in abnormal gait or abnormal spinal contour…” The Board reviewed to see if a higher evaluation was achieved coding with 5243 (Intervertebral disc syndrome) based on incapacitating episodes, but there was no documentation in record of incapacitating episodes of at least one week in the past 12 months to meet the threshold for a compensable evaluation.

There was no evidence of a radiculopathy or other neurological disorder associated with the back condition to provide additional 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 back 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 matters of the right hip condition and in the back condition, both IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudications. 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 20140221, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record

XXXXXXXXXXXXXXXXXX
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 XXXXXXXXXXXXXXXXXX, AR20150008695 (PD201400919)

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

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AF | PDBR | CY2014 | PD-2014-00919

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