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AF | PDBR | CY2014 | PD-2014-01251
Original file (PD-2014-01251.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXX    CASE: PD-2014-01251
BRANCH OF SERVICE: Army  BOARD DATE: 20150203
SEPARATION DATE: 20070321


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-1 (Healthcare Specialist) medically separated for low back pain (LBP). The 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 “low back pain with L4-5, L5-1 herniated nucleus pulposus” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. No other conditions were submitted by the MEB. The Informal PEB adjudicated “right paracentral protrusion L4-5 and larger protrusion excursion and right paracentral and lateral recess position at L5-S1 without significant neurologic deficit” as unfitting, rated 10%. The CI made no appeals and was medically separated.


CI CONTENTION: “Significantly affecting my daily quality of life, permanent injury rated at 10% even though PEB found 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 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 20070307
 VA - (2 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Rt Paracentral Protrusion L4-5 & Larger Protrusion Excursion, Rt Paracentral & Lateral Recess Position at L5-S1 5241 10% Low Back Pain w/ L4-5, L5-S1 Herniated Nucleus Pulposus 5243 10% 20070511
Other x 0 (Not in Scope)
 Other x 1
Rating: 10%
 Combined: 10%
Derived from VA Rating Decision (VA RD ) dated 200 70914 ( most proximate to date of separation [ DOS ] ).

ANALYSIS SUMMARY:

Lumbar Spine Condition. The CI sustained a low back injury in a motor vehicle accident in June 2006. Ongoing back pain that radiated to the legs and occasional leg numbness were evaluated with magnetic resonance imaging, which showed disc herniations at L4-5 and L5-S1. However, surgery was not warranted. The back pain did not respond sufficiently to activity modification, physical therapy and medications to allow return to full duties. A Pain Clinic examination on 13 October 2006 (5 months prior to separation) recorded a normal gait and spine appearance. Muscle spasms and signs of nerve root irritation were absent, but painful lumbar motion was present. A detailed lower extremity neurologic exam was normal.

The narrative summary approximately 4 months prior to separation noted a complaint of back pain and intermittent right foot numbness. Examination showed normal gait and no muscles spasm. Neurological findings of the lower extremities, including muscle strength, were normal.

At the VA Compensation and Pension exam performed 2 months after separation, the CI reported difficulty bending, and experienced flare-ups of back pain twice per week. Pain interfered with his sleep, but he was taking no medications for pain. Examination showed a normal gait. There was no additional limitation in spine motion after repetitive motion. Signs of nerve root impingement were absent, and neurologic findings were normal. The goniometric range-of-motion (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)		 NARSUM ~ 4 Mo s . Pre-Sep VA C&P ~ 2 Mo s . Post-Sep
Flexion (90 Normal) 85 70
Combined (240) 220 220
Comment +Tenderness --
§4.71a Rating 10% 10%

The Board directed attention to its rating recommendation based on the above evidence. The PEB assigned a 10% rating and, although there was no history of lumbar surgery, used the 5241 code (spinal fusion). Choice of lumbar spine code however had no bearing on rating under the general spine formula. The VA also assigned a 10% rating under the 5243 code (Intervertebral disc syndrome). The Board agreed that the evidence supported a 10% rating, but no higher, for flexion greater than 60 degrees but not greater than 85 degrees; and combined ROM greater than 120 degrees but not greater than 235 degrees. There was no evidence of muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour, and therefore the next higher 20% rating was not justified. The Board also considered rating intervertebral disc disease under the alternative formula for incapacitating episodes, but could not find sufficient evidence which would meet a minimal rating under that formula. The Board finally deliberated if additional disability was justified for possible peripheral nerve impairment. The CI complained of intermittent radiating pain to the lower extremities and intermittent right foot numbness. However, the CI denied muscle weakness, and examinations recorded normal neurologic findings, including muscle strength. The presence of functional impairment with a direct impact on fitness is the key determinant in the Board’s decision to recommend any condition for rating as additionally unfitting. There is no evidence in this case of functional impairment attributable to peripheral neuropathy. While the CI experienced some radiating pain, this is subsumed under the general spine rating criteria, which specifically states “with or without symptoms such as pain (whether or not it radiates).” The Board therefore concludes that additional disability was not justified on this basis.
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 lumbar spine 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 lumbar right paracentral protrusion of L4-5 and L5-S1 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 re-characterization of the CI’s disability and separation determination.


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20140310, 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, AR20150009559 (PD201401251)


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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