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AF | PDBR | CY2014 | PD-2014-01033
Original file (PD-2014-01033.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXX    CASE: PD-2014-01033
BRANCH OF SERVICE: Army  BOARD DATE: 20150116
SEPARATION DATE: 20080331


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was a National Guard E-5 (M1 Armor Crewman) medically separated for a back condition. The back condition 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 back condition, characterized as “chronic low back pain [LPB] with lumbar neuritis due to degenerative disc disease (DDD),” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. The MEB also identified and forwarded three other conditions as medically acceptable. The Informal PEB adjudicated “lumbar degenerative disc disease” as unfitting, rated 10%, with likely application of the VA Schedule for Rating Disabilities (VASRD). The remaining conditions were determined to be not unfitting. The CI made no appeals and was medically separated .


CI CONTENTION: The CI writes: “The rating decision should be changed to reflect my current VA Service-Connected disability rating which rendered me unfit for service.”


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 :

Service Admin IPEB – Dated 20080313
 VA - (2 Mos. Pre-Separation)
Condition
 Code Rating Condition Code Rating Exam
Lumbar DDD 5299-5242 10% DDD Thoracolumbar Spine 5242 20% 20080121
Radiculopathy, LLE 8520 10% 20080121
Other x 3 (Not in Scope)
 Other x 1 20080121
Combined: 10%
 Combined: 40%
Derived from VA Rating Decision (VA RD ) dated 200 80801 ( most proximate to date of separation [ DOS ] ).


ANALYSIS SUMMARY:

Lumbar Degenerative Disc Disease. The first record in evidence for the LBP condition was a noted dated 6 July 2007 at which the CI complained of left leg pain from the buttock to the leg since lifting weights. He was next seen on 2 August 2007 for a 1-month history of left leg pain and LBP noting an insidious onset. His neurological examination was normal as was the range-of-motion (ROM). He began treatment in physical therapy (PT), but the pain persisted and he was evacuated to Germany for further evaluation. On 9 October 2007, lumbar X-rays were unremarkable, but thoracic X-rays showed some degenerative changes. A magnetic resonance imaging that day was significant for a disc bulge at L4-5 and a tear at L5-S1. He was seen the next day in neurosurgery and reported symptoms beginning in pre-deployment training and then aggravated lifting weights while deployed. The CI reported that the entire left leg was numb and weak. On examination, the CI was tender along the left paraspinal muscles and provocative testing for nerve root irritation was positive on the left. The ROM was normal as were the gait and motor examination. Sensation was reduced along the lateral left calf. He was diagnosed with DDD, a herniated disc, and lumbar neuritis (inflammation of the lumbar nerves). He was redeployed for further evaluation, treatment, and disposition and evaluated in neurosurgery on 16 October 2007. He reported “tingling” which radiated to his left foot, but that the pain had resolved. On examination, sensation, motor function, reflexes, and gait were normal. However, a PT note dated 2 November 2007 documented persistent pain and tingling of the left leg. At a follow-up appointment on 14 November 2007, he had continued symptoms and a reduction in extension and rotation of the spine, but normal flexion although painful after 50 degrees. The CI was seen in community care on 26 November 2007 and noted constant pain, but that he took no medications for it. The CI did not want to continue on active duty and wanted to enter the MEB process. His gait and neurological examination were normal. The narrative summary was dated 18 December 2007. The CI reported that his LBP began after mobilization but that he was “able to work through it.” He reported occasional numbness and tingling down to the left foot which was reduced from when deployed. The LBP was constant. On examination, he was in no distress and had a normal gait. He was tender to palpation and one sign of non-organic pain was present. The neurological examination was normal although the right knee reflex was increased from normal. Provocative nerve root testing was positive on the left (as before.) The ROM was reduced for flexion and limited by pain. The CI was seen in physical medicine on 4 January 2008 for electrodiagnostic testing (EDX). The CI was noted to have normal motion without spasm. Provocative nerve root testing was negative. The motor examination, reflexes, and gait were normal. The EDX was normal. At the MEB examination on 8 January 2008, the reflexes were normal. Flexion was slightly reduced. Provocative nerve root testing was negative.

The VA Compensation and Pension (C&P) examination was performed on 21 January 2008, 2 months prior to separation, the CI reported a 21-year history of LBP (this may be a typo) which had not resulted in incapacitation. He also reported long standing left foot pain. The 66 inch CI was noted to weigh 220 pounds. On examination, he was noted to have normal posture, but his gait was abnormal as he guarded it against pain. He was noted to have lumbar spasm and provocative nerve root testing was positive on the left. Spinal curvature was normal. The ROM was reduced as documented below. There was no additional limitation with repetition. The reflexes were normal; the motor examination was not documented. Sensation was abnormal at L4, L5, and S1 and thought to represent a sciatic nerve (peripheral nerve) abnormality. The CI was also noted to have a tender left foot and the abnormal gait was also cited here. The relative contribution was not addressed by the examiner.

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.

Thoracolumbar ROM
(Degrees)		 MEB ~3 Mo. Pre-Sep VA C&P ~2 Mo. Pre-Sep
Flexion (90 Normal) 70 70
Combined (240) 205 160
Comment ROM limited by pain Spasm and abn gait; abnormal foot examination ; DeLuca negative
§4.71a Rating 10% 10/20%

The Board directed attention to its rating recommendation based on the above evidence. The PEB rated the back condition at 10% using an analogous code 5299-5242 (degenerative arthritis of the spine). The VA also used code 5242, but rated the back at 20% citing spasm and an abnormal gait. The Board noted that the VA C&P examination was the only time an abnormal gait was recorded in the records in evidence. The abnormal gait was listed under both the back and the left foot conditions and not specifically attributed to either. The VASRD does rate spasm causing an abnormal gait at 20%. While the VA rater made this connection, the examiner did not. The gait was typically recorded as normal. The Board majority determined that the evidence is not sufficient to support a conclusion that there was an abnormal gait secondary to spasm present at separation. The Board also considered if an unfitting neuropathy (nerve problem) secondary to the back condition was present at separation, but the evidence does not support such a determination. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board majority 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 matter of the lumbar DDD condition and IAW VASRD §4.71a, the Board, by majority vote, 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 re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20140227, w/atchs
Exhibit 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 XXXXXXXXXXXXXXX, AR20150011030 (PD201401033)


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

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