Search Decisions

Decision Text

AF | PDBR | CY2014 | PD-2014-02142
Original file (PD-2014-02142.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXX    CASE: PD-2014-02142
BRANCH OF SERVICE: Army  BOARD DATE: 20150116
SEPARATION DATE: 20060527


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5 (Military Police) medically separated for thoracic spine condition. The condition could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty, but was authorized to perform an alternate physical fitness test (per PROFILE). She was issued a permanent U3L2 profile and referred for a Medical Evaluation Board (MEB). The “chronic upper back pain” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. The MEB also identified and forwarded three other conditions as medically acceptable, for PEB adjudication. The Informal PEB adjudicated “chronic upper back pain…without neurologic abnormality” as unfitting, rated 10% with likely application of the VA Schedule for Rating Disabilities (VASRD). The remaining conditions we re determined to be not unfitting . 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 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 :

IPEB – Dated 20060228
 VA* - (~9 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Chronic Upper Back Pain…Without Neurologic Abnormality 5237 10% Thoracic Spine Strain 5237 20% 20070209
Endometriosis Not Unfitting Endometriosis 7629 0% 20070209
Dysthymic Disorder Not Unfitting PTSD …MDD 9411 NSC 20070209
Bilateral Knee Pain Not Unfitting PFS, Right Knee 5024 NSC 20070209
PFS, Left Knee 5024 NSC 20070209
Other x 0 (Not In Scope)
 Other x 8 (Not In Scope)
RATING: 10%
 RATING: 20%
* Derived from VA Rating Decision (VA RD ) dated 200 70703 (most proximate to date of separation ( DOS ) ) .


ANALYSIS SUMMARY: The records of the initial back injury and treatment were not available in evidence before the Board and could not be located after appropriate inquiries. A further attempt at obtaining the relevant documentation would likely be futile and introduce additional delay in processing the case; and, it is was judged by the members that the missing evidence would not materially alter the Board’s recommendations.

Chronic Upper Back Pain Condition. The CI was in a car accident on 3 November 2004. Lumbar X-rays (possibly taken the day prior) and thoracic spine X-rays were normal. No other records were available for review until the CI was entered into the MEB process for chronic pain. The commander’s statement dated 22 November 2005 noted that her back pain prevented her from completing all required duties, but that she could qualify on a pistol and alternate physical fitness test. She was not deployable, but could perform administrative duties. In the narrative summary (NARSUM) dated 17 January 2006, the CI reported constant back pain since the car accident in November 2004. She had been treated with medications, physical and chiropractic therapy, and injections with only temporary relief. Her pain was aggravated by activity, but was not predictable. It was noted that a magnetic resonance imaging of the thoracic spine in March 2005 was normal. On examination, her gait and stance were normal. The back was tender to palpation, but spasm not recorded. The range-of-motion (ROM) is below. Painful motion was not recorded. Strength and reflexes were normal. At the VA Compensation and Pension (C&P) examination performed on 9 February 2007, 9 months after separation, the CI reported chronic back pain with daily flares. She used foot orthotics and knee braces. Incapacitation was not recorded. On examination, she was noted to walk with a minimal arm swing and a stiff appearing back. Some flattening of the normal thoracic curve was present. Spasm was present. Sensation and reflexes were normal. Some weakness of both the upper and lower extremities was present, but not in a particular pattern.

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 ~4 Mo. Pre-Sep VA C&P ~9 Mo. Post-Sep
Flexion (90 Normal) 90 60
Combined (240) 210 110
Comment N or m a l gait, no spasm Limited by pain
§4.71a Rating 10 % 20 %

The Board directed attention to its rating recommendation based on the above evidence. The PEB and VA both coded the back condition 5237 (lumbosacral strain) but rated it 10% and 20% respectively. The NARSUM supports a 10% rating; however, the VA C&P examination, accomplished 9 months after separation, supports a 20% rating. The Board observed that the ROM values reported by the VA examiner are significantly worse than those reported by the MEB examiner. However, there is no record of recurrent injury or other development in explanation of the more marked impairment reflected by the VA measurements. While ROM limitations may have progressed over time, there is no evidence in the record from which to conclude that the severity at separation approached that portrayed by the VA measurements. 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 in consideration of the preponderance of the evidence, the Board majority concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the back condition.

Contended PEB Conditions. The Board’s main charge is to assess the fairness of the PEB’s determination that the contended dysthymic disorder, bilateral knee pain, and endometriosis were not unfitting. The Board’s threshold for countering fitness determinations requires a preponderance of evidence, but remains adherent to the DoDI 6040.44 “fair and equitable” standard. These conditions were not implicated in the commander’s statement and were not judged to fail retention standards. The knee pain was given an L2 profile. The dysthymic disorder was mentioned on the final profile, but the CI retained an S1 profile. All were reviewed and considered by the Board. There was no performance based evidence from the record that any of these conditions significantly interfered with satisfactory duty performance. After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the any of the contended conditions and so no additional disability ratings are 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 upper back pain condition and IAW VASRD §4.71a, the Board, by majority vote, recommends no change in the PEB adjudication. In the matter of the contended dysthymic disorder, bilateral knee pain, and endometriosis conditions, the Board unanimously recommends no change from the PEB determinations as not unfitting. 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 20140425 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, AR20150010554 (PD201402142)


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

Similar Decisions

  • AF | PDBR | CY2014 | PD-2014-01688

    Original file (PD-2014-01688.rtf) Auto-classification: Approved

    The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of theVeterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation. The VA also granted a 0% service-connected rating for right radiculopathy associated with the cervical spine disease, citing the normal neurologic examination at the time of the pre-separation VA C&P examination. The...

  • AF | PDBR | CY2013 | PD-2013-02197

    Original file (PD-2013-02197.rtf) Auto-classification: Approved

    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 thoracic musculoskeletal condition is addressed below.The requested bilateral knee condition, lumbar spine condition, left hand ulnar nerve dysfunction and hypertension (determined to be not unfitting by the PEB) are also addressed below.The...

  • AF | PDBR | CY2013 | PD-2013-02730

    Original file (PD-2013-02730.rtf) Auto-classification: Approved

    Post-Separation) ConditionCodeRatingConditionCodeRatingExam Chronic Low Back Pain523710%Strain, Thoracolumbar Spine523710%20070521Other x0 (Not in Scope)Other x 6(Not in Scope)20070521 Combined: 10%Combined:50%Derived from VA Rating Decision (VARD)dated 20070618 ( most proximate to date of separation) Chronic LBP Condition . Physical therapy ROM was TL flexion of 50 degrees (normal 90 degrees) and TL combined ROM of 152 degrees (normal 240 degrees) with ROM noted to be limited by pain.At...

  • AF | PDBR | CY2013 | PD-2013-02128

    Original file (PD-2013-02128.rtf) Auto-classification: Denied

    On exam there was TTP of the neck with negative testing for nervecompression (Spurling’s), with normal ROM and normal bilateral UE examination.At the MEB examination on 21 October 2004, 6 months prior to separation, the CI reported chronic neck pain without radicular symptoms. The NARSUM notes the CI had a history of hip pain (trochanteric bursitis), with normal bilateral hip X-rays.Notes in the STR indicated that in April 2000 the CI reported 5 weeks of right hip pain. At the MEB...

  • AF | PDBR | CY2013 | PD 2013 00095

    Original file (PD 2013 00095.rtf) Auto-classification: Approved

    Despite the CI’s remarks of pain during portions of flexion of both knees, the VA C&P noted that examination of his knee on 10 June 2003 “ was grossly unremarkable” the examiner of on to state that the knee examination revealed “ no soft tissue swelling, no point tenderness, or joint effusion and there was no ligamentous instability appreciated.” After due deliberation in consideration of the preponderance of the evidence, the Board concluded there was insufficient cause to recommend a...

  • AF | PDBR | CY2013 | PD-2013-02401

    Original file (PD-2013-02401.rtf) Auto-classification: Denied

    There was no effusion and no instability.At the VA C&P examination on 11 May 2005 (approximately 6 weeks after separation), the CI reported left knee pain aggravated by activity and reported giving away symptoms, and easy fatigability.On examination there was an antalgic gait. The PEB rated the left knee condition 10% coded 5259, symptomatic status post removal of meniscus, noting full motion and good stability. The “minus 10 degrees” was in the context of reporting onset of painful...

  • AF | PDBR | CY2014 | PD-2014-00313

    Original file (PD-2014-00313.rtf) Auto-classification: Denied

    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. At the NARSUM exam, 2 months prior to separation, the CI had tenderness to palpation over the mid-thoracic spine, normal gait and normal strength and sensation in the lower extremities. DoD Physical Disability Board...

  • AF | PDBR | CY2012 | PD2012-00270

    Original file (PD2012-00270.pdf) Auto-classification: Approved

    RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW BRANCH OF SERVICE: ARMY SEPARATION DATE: 20070116 NAME: CASE NUMBER: PD1200270 BOARD DATE: 20121121 SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an Active Guard Reserve (AGR) SGT/E-5 (42A/Human Resources Specialist), medically separated for chronic low back pain. In the matter of the chronic low back pain condition, the Board unanimously recommends a disability...

  • AF | PDBR | CY2013 | PD-2013-01641

    Original file (PD-2013-01641.rtf) Auto-classification: Approved

    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 reviewed both exams present for review to arrive at its rating recommendation. BOARD FINDINGS : IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB...

  • AF | PDBR | CY2013 | PD2013 01034

    Original file (PD2013 01034.rtf) Auto-classification: Denied

    The rating for the unfitting chronic mid back pain condition is addressed below; and, no additional conditions are within the DoDI 6040.44 defined purview of the Board.However, the CI additionally was notified by the Army that his case may be eligible for a review of the military disability evaluation of any mental health (MH) condition, in accordance with Secretary of Defense directive for a comprehensive review of Service members who were referred to a disability evaluation process between...