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AF | PDBR | CY2014 | PD-2014-01845
Original file (PD-2014-01845.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXX  CASE: PD-2014-01845
BRANCH OF SERVICE: Army  BOARD DATE: 20141231
SEPARATION DATE: 20050818


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Track Vehicle Repairer) medically separated for chronic low back pain (LBP). The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty. He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB). The condition, characterized as “chronic low back pain” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. The MEB also identified and forwarded one other condition (mild hypercholesterolemia) for PEB adjudication. The Informal PEB adjudicated “chronic radiating low back pain” as unfitting, rated 10%. The remaining condition w as determined to be not unfitting and therefore not ratable. The US Army Physical Disability Agency issued an Administrative Correction that did not change the disposition or rating. The CI made no appeals and was medically separated.


CI CONTENTION: “Please consider all conditions”


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 Admin IPEB – Dated 20050726
 VA* - (2 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Chronic Radiating Low Back Pain 5243 10% Herniated Nucleus Pulposus at L5-S1 S/P Discectomy 5243 10% 20051028
Mild Hypercholesterolemia Not Unfitting No VA Entry
Other x 0 (Not In Scope)
 Other x 0
Combined: 10%
 Combined: 10%
*Derived from C&P Exam dated 20051028 (most proximate to date of separation (DOS))



ANALYSIS SUMMARY:

Low Back Condition. While deployed, the CI injured his low back in a roll-over motor vehicle accident in December 2003. Despite symptoms, he was able to complete his deployment tour and returned home in March 2004. The intensity of his back pain increased with radicular symptoms extending into the left hip and leg. Radiologic testing revealed a single level lumbosacral herniated disc as well as degenerative arthritis. He underwent an aggressive physical therapy and home exercise program as well as spinal injections, which were unsuccessful in providing long term pain relief. In March 2005, he had spinal surgery to remove the herniated disk. His recovery was uneventful and within 8 weeks he reported having “minimal back pain” and simply a dull ache in his upper thigh. There were no periods of VA Schedule for Rating Disabilities (VASRD) defined incapacitation.

At a fitness for duty examination performed 2 weeks prior to the MEB narrative summary (NARSUM) the CI endorsed worsening LBP, left thigh and foot numbness, and the inability to run, bend at the waist, or lift greater than 30 pounds. His physical examination (PE) revealed decreased lumbosacral range-of-motion (ROM), sensory deficit in the left thigh and calf, and altered sensation to the left foot noting a “positive straight leg raise (SLR).” Plain film X-rays of the lumbar spine were normal.

At the NARSUM examination (6 weeks prior to separation), the CI reported “…being essentially pain free when he is not performing any activity; however, any lifting, twisting, hamstring stretches, walking or standing for prolonged periods, all worsen the pain, including radiation of pain into his left hip.” The PE was limited and revealed pain-positive left SLR, and painful limited ROM. There was no comment with regards to the presence of tenderness, guarding, or spasms. The diagnosis was LBP with L5-S1 herniated disc with surgical description.

At the VA Compensation and Pension examination (2 months after separation), the CI reported constant LBP with extension into his left leg and foot made worse with prolonged sitting, bending, lifting weight, and twisting. The VA PE revealed normal gait and posture. There was para-spinal spasms and limited painful motion present without spinal tenderness. He was neurologically intact. There was no edema, redness, effusion, or swelling associated with the back or either lower extremity. His diagnosis remained unchanged. 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)
 FFD ~ 8 weeks Pre-Sep
(20050610)
 MEB ~ 6 weeks Pre-Sep
(200 50630 )
 VA C&P ~ 8 weeks Post-Sep
(20051028)
Flexion (90 Normal)
 75 52, 56, 61 (60) 85
Extension (30)
 10 50, 45, 46 (45) 30
R Lat Flexion (30)
 30 28, 24, 24 (25) 35
L Lat Flexion (30)
 30 21, 25, 26 (25) 35
R Rotation (30)
 30 27, 32, 28 (30) 35
L Rotation (30)
 30 32, 34, 32 (30) 35
Combined (240)
 205 215 255
Comment
 N ormal gait;
 ( + ) SLR ;
 decrease sensation (L)		 (+) P ainful motion;
 (+) SLR 		N ormal gait;
(+) painful motion;
 (+) spasms
§4.71a Rating
 10% 20% 10%

The Board directed attention to its rating recommendation based on the above evidence. Although the PEB and VA titled the unfitting back condition slightly differently, they both utilized code 5243 (Intervertebral disc syndrome) citing tenderness by the PEB and presumed painful motion by the VA. Board members first agreed that sufficient evidence of limited ROM was present to justify the rating of 10%. Additionally, members considered application of §4.40 (functional loss) which states “a part which becomes painful on use must be regarded as seriously disabled” as seen on the VA examination as painful motion with spasms. In regards to exam probative value, members agreed that all three charted encounters near equivalent in exam depth, accuracy, and date reference to separation. Based upon the totality of the record, all Board members agreed that despite the single rate-changing MEB ROM flexion measurement, the CI’s overall condition was more consistent at a 10% impairment rating. There were no available alternative or analogous coding options which were applicable and or advantageous to the CI’s current 10% rating. 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. The pain component of a radiculopathy is subsumed under the general spine rating as specified in §4.71a. Considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), members agreed that a disability rating of 10% for the LBP condition was appropriately recommended in this case.

Contended PEB Conditions.

Hypercholesterolemia (Hyperlipidemia). The hyperlipidemia condition is neither linked to fitness nor considered a ratable condition under the VASRD.


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 LBP condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication. In the matter of the contended hypercholesterolemia condition, the Board unanimously agrees that it cannot recommend it for additional disability rating. 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 20140430, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record








                                   
XXXXXXXXXXXXXXXXX
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 XXXXXXXXXXXXXXXXX , AR20150008205 (PD201401845)

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

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