Search Decisions

Decision Text

AF | PDBR | CY2014 | PD-2014-02943
Original file (PD-2014-02943.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXX     CASE: PD - 2014 -02943
BRANCH OF SERVICE: Army   BOARD DATE: 201 5 0526
Separation Date: 20090207


SUMMARY OF CASE : Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated National Guard E-4 ( Airborne Infantryman) medically separated for back pain. The condition could not be adequately rehabilitated to meet the physical requirements of his M ilitary Occupational Specialty or satisfy physical fitness standards. He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB). The “chronic low back pain ( LBP) with degenerative disk disease ( DDD) at L3-4 and L4-5” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. The MEB also identified and forwarded one other condition (adjustment disorder) for PEB adjudication. The Informal PEB adjudicated his back condition as unfitting, rated 10% , with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD). The remaining condition (adjustment disorder) was determined to be not compensable . The CI made no appeal s 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 20081120
 VA* - Service Treatment Records (STR) and VA Record
Condition
 Code Rating Condition Code Rating Exam
Chronic LBP with DDD at L3-4 and L4-5 5299-5243 10% DDD, Lumbar Spine 5242 0% Missed Exam
Adjustment Disorder Not Compensable Post-Traumatic Stress Disorder (PTSD) 9411 10% 20100805
Other x 0 (Not In Scope)
 Other x 4
RATING: 10%
 RATING: 20%
*Derived from VA Rating Decision (VARD) dated 20101005 (most proximate to date of separation [DOS]).


ANALYSIS SUMMARY :

 Chronic LBP with DDD at L3-4 and L4-5 Condition . The CI injured his lower back when his vehicle rolled over in November 2006. He experienced an electrical shock that radiated from his lower back down his left leg. A lumbosacral spine magnetic resonance imaging ( MRI ) demonstrated a left large disc pr o trusion (herniated disc-HNP) at L4-5 and a moderate central disc protrusion at L3-4. He continued with the left leg pain, weakness and fatigue and was diagnosed with a lumbar radiculopathy at L5 . Orthopedist evaluation in June 2007 noted that the CI continued with LBP that radiated to the left buttock. There were physical exam findings of pain limited motion with a normal motor and sensory and reflexes.

A Neurosurgeon MEB consult evaluation in August 2008 noted that the CI had failed physical therapy and steroid injections, and consult indicated that the CI “had improvement since a radiofrequency rhizotomy procedure ( damage or destroy targeted nerves by needle radio wave generated heat). He still has back pain but the radi cular component has improved.” The motor, sensory and reflex exams were all normal. The MEB narrative summary exam approximately 5 months prior to separation documented that the CI continued to have LBP which was exacerbated by twisting, lifting, bending and sneezing and limitations in sitting, standing and walking. He had flares that occurred once daily for approximately 2 hours caused by prolonged standing and walking. There were range - of - motion (ROM) physical exam findings based on an average of three repetitions of flexion limited to 70 degrees (normal 90) and a combined 205 degrees (normal 240) . There was a normal gait and the CI was able to heel walk and toe walk. There was tenderness ; and mild lumbar muscle spasm . S trength was “5-/5 weakness of left foot dorsiflexion” with all other muscle groups with normal 5/5 strength. R eflexes and sensory testing were normal. A VA treatment entry 8 months after separation noted some lumbar tenderness and a repeat back MRI demonstrated multilevel DDD without central stenosis. The CI did not show for his scheduled (August 2010) VA Compensation and Pension exam for his spine condition .

The Board directed attention to its rating recommendation based on the above evidence. The PEB coded the LBP condition as 5299 analogous to 5243 ( Intervertebral disc syndrome ) and rated at 10%. The VA coded the lumbar spine condition as 5242 (d egenerative arthritis of the spine ) and rated at 0% based on the STR citing a missed exam . The “General Rating Formula for Diseases and Injuries of the Spine ” considers the CI’s pain symptoms “with or without symptoms such as pain (whether or not it radiates), stiffness or aching in the area of the spine affected by residuals of injury or disease . ” The CI had a forward flexion of 70 degrees and combined ROM of 205 degrees which met the 10% rating criteria of forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or combined ROM greater than 120 degrees but not greater than 235 degrees. There was no evidence of more limited ROMs, incapacitating episodes, or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour for any rating above 10%. 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 i n the PEB adjudication for the c hronic LBP with DDD at L3-4 and L4-5 condition without the addition of a peripheral neuropathy condition.

The Board next considered if there was an unfitting residual peripheral nerve condition. Firm Board precedence requires a functional impairment linked to fitness to support a recommendation for addition of a peripheral nerve rating to service disability in spine cases. The pain component of a radiculopathy is subsumed under the general spine rating as specified in §4.71a. There was episodic finding of left foot dorsiflexion weakness of 5-/5 which did not impact gait or heel and toe walking and there were no sensory or reflex deficits. There is thus no evidence of a separately ratable functional impairment (with fitness implications) from the residual radiculopathy; and, the Board cannot support a recommendation for an additional Service disability rating on this basis.

 Contended PEB Conditions. The contended condition adjudicated as not compensable by the PEB was a djustment d isorder . The Board’s first charge with respect to th is condition is an assessment of the appropriateness of the PEB’s adjudication that it was “not compensable, although it may be administratively unfitting.” IAW DoDI 1332.38, Enclosure 5 , in effect at the time, “ adjustment disorders ” are “conditions which do not constitute a physical disability” and are therefore not compensable under the DoD disability evaluation system. The Board concluded that the PEB adjudication for adjustment disorder was correct and, therefore, no additional disabil ity rating can be 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 c hronic LBP with DDD at L3-4 and L4-5 condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication. In the matter of the contended a djustment d isorder condition , the Board unanimously recommends no ch ange from the PEB determination as not compensable . 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 20 140612 , w/atchs
Exhib it 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, AR20150015246 (PD201402943)

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-2014-00452

    Original file (PD-2014-00452.rtf) Auto-classification: Approved

    A review of my medical records will show this. 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. I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum.

  • AF | PDBR | CY2013 | PD-2013-01816

    Original file (PD-2013-01816.rtf) Auto-classification: Denied

    The commander’s statement noted that the CI’s back condition precluded him from performing critical field tasks, his condition further interfered with his MOS duties and adversely affected his unit’s readiness.The MEB narrative summary (NARSUM) exam approximately 5 monthsprior to separation documented that the CI was seen in the ER on 3 October 2003 and given intravenous morphine for acute LBP and that he still had occasional moderate LBP. RECOMMENDATION : The Board, therefore, recommends...

  • AF | PDBR | CY2014 | PD-2014-01999

    Original file (PD-2014-01999.rtf) Auto-classification: Denied

    Pre-Separation) ConditionCodeRatingConditionCodeRatingExam Chronic Back Pain, due to Degenerative Disk Disease, without Neurologic Abnormality5299-524220%Residuals, Lumbar Injury w/Traumatic Arthritis5010-523740%20040519Lumbar Radiculopathy, Right Leg (claimed as leg numbness) associated w/Residuals, Lumbar Injury w/Traumatic Arthritis852020%20040519Lumbar Radiculopathy, Left Leg (claimed as leg numbness) associated w/Residuals, Lumbar Injury w/Traumatic Arthritis852010%20040519Other x 0...

  • AF | PDBR | CY2014 | PD-2014-00077

    Original file (PD-2014-00077.rtf) Auto-classification: Approved

    An epidural block performed in April 2006 was ineffective for pain relief.A lumbar spine X-ray showed localized narrowing of the disc space between L4-5 with DDD. The MEB narrative summary (NARSUM) exam approximately 4 months prior to separation documented that the CI had daily pain rated at 5/10 that increased to 8/10 pain and spasm with activity.The MEB NARSUM physical exam findings were normal forward flexion with a combined range-of-motionof 215 (240 is normal) with marked spasm,...

  • AF | PDBR | CY2014 | PD-2014-01525

    Original file (PD-2014-01525.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 theVASRD standards to the unfitting medical condition at the time of separation. The CI was given a permanent U3 profile for cervical degenerative disease (neck pain) and another medical condition, with a Code C and specific restrictions noted on the profile.The VA C&P exam approximately 2 months prior to separation documented that the CI reported...

  • AF | PDBR | CY2013 | PD-2013-01856

    Original file (PD-2013-01856.rtf) Auto-classification: Denied

    The condition was characterized by the MEB as “chronic low back pain with lumbar degenerative disc disease” and it was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. The PEB adjudicated “chronic low back pain”…with “no neurological deficits “as unfitting, rated 10%citing criteria of the VA Schedule for Rating Disabilities (VASRD).The remaining condition was determined to be “medically acceptable.” The CI made no appeals and was medically separated. Contended Pain and...

  • AF | PDBR | CY2012 | PD-2012-01924

    Original file (PD-2012-01924.txt) Auto-classification: Denied

    RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW NAME: XXXXXXXXXXXXXX BRANCH OF SERVICE: ARMY CASE NUMBER: PD1201924 SEPARATION DATE: 20060626 BOARD DATE: 20130319 SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SGT/E-5 (11B/Infantry) medically separated for chronic low back pain (LBP). CI CONTENTION: “The Army rated my Radiculopathy and Lumbar facet together as the VA. RECOMMENDATION: The Board,...

  • AF | PDBR | CY2013 | PD-2013-02384

    Original file (PD-2013-02384.rtf) Auto-classification: Approved

    Chronic Back Pain Due To Lumbar DDD/Extruded Discs Condition . Pre-SepVA C&P 16 Days Pre-SepFlexion (90 Normal)65Used ROM’s from PT exam60Combined (240)210210CommentPos. invalid font number 31502 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...

  • AF | PDBR | CY2013 | PD 2013 01162

    Original file (PD 2013 01162.rtf) Auto-classification: Approved

    The lumbar spine condition, characterized as “lumbar degenerative disc disease and spondylolysis with low back pain” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. CI CONTENTION : “ At the time of my evaluation it was determined that I had several problems with my lower back. 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...

  • AF | PDBR | CY2012 | PD-2012-00761

    Original file (PD-2012-00761.pdf) Auto-classification: Denied

    RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW NAME: XXXXXXXXXXXX BRANCH OF SERVICE: ARMY CASE NUMBER: PD1200761 SEPARATION DATE: 20020116 BOARD DATE: 20121218 SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was a National Guard Soldier, SGT/E‐5 (45E, assigned to a Hull Systems Mechanic slot, 63E), medically separated for chronic low back pain (LBP) accompanied by neck pain with degenerative disc disease (DDD) at...