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AF | PDBR | CY2014 | PD-2014-02852

Original file (PD-2014-02852.rtf) Auto-classification: Denied

RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXX CASE: PD-2014-02852
BRANCH OF SERVICE: Army BOARD DATE: 20141218

SEPARATION DATE: 20030605

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Finance Specialist) medically separated for a chronic low back condition. The condition could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty or satisfy physical fitness standards. She was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB). The low back condition, characterized as “chronic low back pain” by the MEB was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. No other conditions were submitted by the MEB. The informal PEB adjudicated “chronic low back pain…” as unfitting, rated 10% with application of DoDI 1332.39 and AR 635-40. 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 IPEB – Dated 20030410	VA - (3 Mos. Pre-Separation)
Condition	Code	Rating	Condition	Code	Rating	Exam
Chronic Low Back Pain	5299-5295	10%	Degenerative Disc Disease (DDD) Lumbar Spine	5293-5292	10%	20030305
Other x 0 (Not in Scope)	Other x 2	20030305
Combined: 10%	Combined: 20%

Derived from VA Rating Decision (VA RD ) dated 200 30621 ( most proximate to date of separation [ DOS ] ).

ANALYSIS SUMMARY:

Chronic Low Back Condition. The 2003 VA Schedule for Rating Disabilities (VASRD) coding and rating standards for the spine, which were in effect at the time of permanent separation, were changed to the current §4.71a rating standards on 26 September 2003, following the CI’s permanent disability disposition. The older ratings were based on a judgment as to whether the disability was mild, moderate or severe. The current standards are grounded in range-of-motion (ROM) measurements. IAW DoDI 6040.44, this Board must consider the appropriate rating for the CI’s back condition at separation based on the VASRD standards in effect at the time of separation.

The CI reported that low back pain (LBP) began during basic training in September 2000, but did not seek medical care until the following year when the problem worsened, especially with physical training. Multi-modality treatment including pain medication, physical therapy and chiropractic care resulted in insufficient improvement. A rheumatology evaluation concluded there was no inflammatory or immune component to the condition. Magnetic resonance imaging (MRI) showed early findings of degenerative disc disease at T12-L1 and L5-S1, but without bulging discs or neuroforaminal impingement. At an orthopedic evaluation on 30 September 2002 (8 months prior to separation) the CI complained of LBP, but occasionally thoracic pain. Prolonged walking or sitting could cause numbness in her feet, which resolved with rest. Pain did not radiate to the lower extremities. ROM assessment showed flexion of 90 degrees (normal to 90 degrees by current standards), extension of 20 degrees (normal 30 degrees) and rotation 30 degrees bilaterally (normal 30 degrees). There were three findings suggestive of non-physiologic pain. Lower extremity muscle strength was normal. The examiner concluded that there was a significant non-organic component to the pain and that surgery was not indicated.

At the narrative summary evaluation on 20 February 2003 (3 months prior to separation), the CI reported she could not lift greater than 35 pounds, sit for prolonged a prolonged time or perform repetitive bending. She could not run, jump, perform push-ups and sit-ups and had difficulty with home maintenance tasks. Physical examination noted a normal gait. She demonstrated good muscle strength and intact sensation. Two signs of non-physiologic pain were present. ROM measurements were identical to the orthopedist’s findings in September 2002. Muscle spasm and spinal contour were not mentioned. A diagnosis of chronic LBP was rendered.

At the VA Compensation and Pension exam on 5 March 2003 (3 months prior to separation) the CI reported she had back pain constantly that traveled to her legs and feet. It was stated that the back condition “does not require bedrest or treatment by a physician” and caused “no functional impairment and no lost time from work.” There were no incapacitating episodes in the previous 12 months. Physical examination noted a normal posture and gait. Examination of the thoracic spine revealed “full range of motion,” tenderness over T12 and painful motion. Examination of the lumbar spine showed no radiating pain on movement or muscle spasm, but tenderness at L5 was present. Lumbar ROM measurement showed flexion of 95 degree, extension of 30 degrees, right and left lateral flexion of 35 degrees (30 degrees normal by current standards) and right and left rotation of 30 degrees. Painful motion was present. Lower extremity muscle strength was normal. X-rays showed decreased disc space at T12-L1 and L5-S1.

The Board directed attention to its rating recommendation based on the above evidence. The PEB rated chronic LBP 10%, coded analogously to 5295 (lumbosacral strain), while the VA assigned the same rating under a combined 5293-5292 code (intervertebral disc syndrome; limitation of motion, lumbar spine). The Board agreed that criteria supporting a rating higher than 10% under the 5295 code are not in evidence (i.e. “with muscle spasm on extreme forward bending, loss of lateral spine motion, unilateral, in standing position”); but debated if a higher rating is supported under other codes in effect at the time of separation. Under the 5292 code a 20% rating is justified for “moderate” limitation of lumbar motion, but based on the evidence at hand Board members concluded that this degree of limitation was not present. Likewise, there was no evidence of incapacitating episodes to warrant a minimal rating under the 5293 code. The Board also considered if symptoms and findings warranted disability ratings under two separate codes (limitation of dorsal spine motion and limitation of lumbar spine motion). Under the VASRD in effect at the time, “both under ankylosis and limited motion, ratings should not be assigned for more than one segment by reason of involvement of only the first or last vertebrae of an adjacent segment.” Board members agreed that involvement of the lowermost thoracic vertebra and uppermost lumbar vertebra in this case represented such an “adjacent segment.” Furthermore, assigning two separate ratings in this case was not warranted IAW VASRD §4.14 (avoidance of pyramiding). The Board finally considered if additional disability was justified for peripheral nerve impairment. Although there were inconsistent complaints of radiating pain and numbness in the feet, MRI showed no nerve root compromise and there was no motor impairment that could be linked to any functional deficit or limitation of specific physical requirements. The Board therefore concluded that additional disability rating for radiculopathy was not justified. 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 LBP 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. As discussed above, PEB reliance on AR 635-40 and DoDI 1332.39 for rating chronic low back pain was operant in this case and the condition was adjudicated independently of that instruction by this Board. In the matter of the chronic LBP 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 20140611, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record

XXXXXXXXXXXXXXX
President

DoD Physical Disability Board of Review

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, AR20150010991 (PD201402852)

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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AF | PDBR | CY2014 | PD-2014-02852

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