IN THE CASE OF:	  

		BOARD DATE:	  22 January 2015

		DOCKET NUMBER:  AR20140003753 


THE BOARD CONSIDERED THE FOLLOWING EVIDENCE:

1.  Application for correction of military records (with supporting documents provided, if any).

2.  Military Personnel Records and advisory opinions (if any).


THE APPLICANT'S REQUEST, STATEMENT, AND EVIDENCE:

1.  The applicant requests reconsideration of his request for correction of his medical evaluation board (MEB) narrative summary to show that he had no spinal abnormalities prior to enlisting in the Army and that he sustained his back injury as the result of a squat rack breaking and collapsing.

2.  The applicant states the records need to be corrected because the weights he was lifting did not fall from any rack, the rack collapsed.  He did not build this rack, it was built by members of the U.S. Army.  By allowing this injustice to continue it would appear that he was negligent and the weights were not placed on the rack correctly.  This is untrue; the rack broke and the weights struck him across his lower back.  This was investigated and he was shown not to be at fault.  He understands that assigning liability is never pleasant, but denying the truth is not pleasant either.  He believes there is a very big difference between weights falling from a rack and a rack collapsing.  The weights did not fall off the rack as some of his records show.  He contends that his original doctor said the rack broke and the evidence will show that he was not negligent.

3.  The applicant also states that he did not have any spinal abnormalities prior to entering the military and this is supported by the fact that the medical examination that he underwent prior to enlistment did not show any abnormalities.




4.  The applicant provides:

* Standard Form 88 (Report of Medical Examination), dated 4 August 1980
* Optional Form 275 (Medical Record Report), dated 30 April 1981, pertaining to Silas B. Hays Army Community Hospital Transfer Summary
* 2 Standard Forms 519-A (Radiographic Report), dated 2 and 4 May 1981
* Optional Form 275, dated 1 July 1981, pertaining to his MEB
* U.S. Army Physical Disability Agency (USPDA) Form 18 (Revised PEB Proceedings) (first page only), dated 10 September 1981
* DA Form 3947 (Medical Board Proceedings), dated 10 July 1981
* Orlando Regional Healthcare, Operative Note/Procedure, dated 30 March 2000

CONSIDERATION OF EVIDENCE:

1.  Incorporated herein by reference are military records which were summarized in the previous consideration of the applicant's case by the Army Board for Correction of Military Records (ABCMR) in Docket Number AR20120001469, on 11 October 2012.

2.  The applicant provides new argument that his condition did not exist prior to enlisting in the Army and new evidence in the form of a Standard Form 88 which shows he underwent a pre-enlistment medical examination on 4 August 1980.  This document and argument were not previously considered by the Board and thereby warrants consideration.  This form indicates that no abnormalities were detected and it was determined that he was qualified for enlistment.

3.  The applicant enlisted in the Regular Army on 4 November 1980.  Upon completion of initial entry training, he was assigned to the 63rd Engineer Detachment, Fort Irwin, CA.

4.  The applicant's record contains a DA Form 2173 (Statement of Medical Examination and Duty Status), dated 28 April 1981, which shows in:

	a.  Section I (To be completed by attending Physician or Hospital Patient Administration):

		(1)  at approximately 1900 hours on 17 March 1981 at Fort Irwin, CA, he "was allegedly lifting weights when barbell fell on his back."  "All other details unknown."

		(2)  it was opined that he was not under the influence of alcohol or drugs at the time of the incident.
		(3)  at 1620 hours on 3 April 1981, he was admitted to Silas B. Hays Army Community Hospital, Fort Ord, CA, and diagnosed with "spondylolisthesis (the forward displacement of a vertebra) L5, S1."

	b.  Section II (To be completed by Unit Commander or Unit Adviser):

		(1)  in item 30 (Details of Accident - Remarks), the applicant "was alone in the weight lifting area of Building Number 322 at the time of [the] accident.  (The applicant) was performing an exercise with weights that specifically calls for other people to be present, when the equipment broke and fell across his back.  (The applicant) also indicated he had a similar injury prior to his enlistment."

		(2)  it was determined that there was no requirement for a formal line of duty (LOD) investigation.

		(3)  the applicant's injury was considered to have incurred in the LOD.

5.  On 26 May 1981, a representative of the Commander, 7th Infantry Division and Fort Ord, Fort Ord, CA, by authority of the Secretary of the Army, confirmed the LOD investigation had been reviewed for completeness and the injury was in the LOD.

6.  The applicant's record contains and he also provides an Optional Form 275 which was rendered as a Transfer Summary on 30 April 1981.  The form shows that he was admitted to Silas B. Hays Army Community Hospital on 3 April 1981 and was scheduled to be transferred on 1 May 1981 following 28 days of hospitalization.  The form also shows the following pertinent information:

	a.  Transfer diagnoses:

		(1)  L5-S-1 spondylolisthesis, existed prior to service (EPTS), service aggravated.

		(2)  Left L5 radiculopathy, probably secondary to diagnosis 1.

	b.  Chief complaint and history:  "This 19-year-old white male had 190 pounds of barbell strike him in the low back 2 1/2 weeks before admission when the frame the barbell was placed on collapsed on top of him.....He has had intermittent low-grade back pain since adolescence that has not hampered him in his day-to-day activities."

	c.  Treatment:  "The patient was initially placed on bed rest with bathroom privileges.  He, however, was poorly compliant with this regimen and had to be counseled several times to stay in bed....Bone scan was obtained and this was negative for any increased activity in the lumbosacral spine.  The interpretation was that, since the spondylolisthesis was not hot, this lesion was not acute and, hence, EPTS."

	d.  The applicant was scheduled to be transported by ambulance on the morning of 1 May 1981 to the Neurosurgery Service at Letterman Army Medical Center. 

7.  His record contains and he also provides a Standard Form 519-A which shows he underwent a metrizamide lumbar myelogram on 5 May 1981.  The examining physician noted there was a "Grade I spondylolisthesis of L5 on S1.  On flexion-extension and neutral positions, there was no evidence of definite motion of L5 with respect to S1 and the Grade I spondylolisthesis remained the same" (indicating that it was the result of an old injury which had healed in the current position).  As a result, the physician's impression was "Grade I spondylolisthesis, L5 on S1, without evidence of herniated nucleus pulposus."

8.  The applicant's record contains and he also provides an Optional Form 275 that was rendered as an MEB Narrative Summary, dated 1 July 1981, which contains the following pertinent information:

	a.  Chief complaint:  Low back pain with radiation to left leg.

	b.  History, in part:

* he gave a history of multiple athletic injuries to his extremities and his back which had been followed by the Orthopedics Service since 1977
* he experienced frequent low back pain during basic training which was exacerbated with exercise and cold weather
* in March 1981, while lifting weights at the Fort Irwin gym, he was struck in the lower back by a barbell that fell from a weight stand
* he noted immediate onset of pain in his lower back and was able to walk, but only with difficulty
* he was evaluated at Silas B. Hayes Army Community Hospital and was found to have decreased strength and sensation in the left lower extremity
* he underwent x-rays of the lumbosacral spine which showed a grade I spondylolisthesis, but no fractures or decreased joint space
* a bone scan was read as within normal limits
* he was treated with bed rest, which was questionably complied with, and physical therapy without improvement

	c.  Past medical history:  Remarkable for multiple athletic injuries resulting in fractures of multiple extremities.

	d.  Hospital Course:  

* he underwent an electromyelogram on 4 May which was read as completely within normal limits
* he underwent a metrizamide lumbar myelogram which showed no abnormalities

	e.  Summary and Recommendations:

* has a history of low back pain and back injury prior to his entrance on active duty
* following his injury in March 1981 evaluation documented presence of a congenital lesion, Grade I spondylolisthesis with spondylolysis, but no evidence of neurologic involvement.
* he declined surgical therapy, and appeared to be poorly motivated to recover from his disability

	f.  The MEB concluded that the applicant had chronic low back pain secondary to a deformity which existed prior to military service.  This condition precluded performance of the duties of his specialty.  His potential for rehabilitation was limited at the time and it was recommended that he be separated from the Armed Forces for reasons of unfitness.

9.  The applicant's record contains and he also provides a DA Form 3947, dated 10 July 1981, that shows an MEB found him medically unfit based on his diagnosis of chronic low back pain secondary to L5-S1 spondylolisthesis with spondylolysis.  This form indicates the applicant was present during the proceedings and presented views in his own behalf.  The MEB recommended the applicant's case be reviewed by a PEB after finding the condition:

* was in the line of duty
* probably occurred at birth
* was not caused by his military service
* EPTS
* was aggravated by active duty

The MEB findings and recommendations were approved on 15 July 1981.  The applicant reviewed and authenticated this document with his signature on 15 July 1981.

10.  The applicant's record contains an electronic message, dated 17 August 1981, Subject:  LOD Determination, which shows the final determination for the injury sustained by the applicant on 17 March 1981 at Fort Irwin, CA, was "in LOD."

11.  His record contains a DA Form 199 that shows a PEB convened on 26 August 1981.  The PEB found him unfit based on the MEB diagnosis, recommended a 0-percent disability rating, and recommended his separation from the service with severance pay if otherwise qualified.  The PEB determined that the applicant's condition was:

* not the result of intentional misconduct, willful neglect, or unauthorized absence
* aggravated while entitled to basic pay
* aggravated in LOD
* the proximate result of performing duty

12.  On 1 September 1981, the applicant concurred with the PEB findings and recommendations and waived a formal hearing of his case.

13.  His record contains a USAPDA Form 18, dated 10 September 1981, which shows the USAPDA revised the PEB findings by increasing his disability rating to 10 percent.  On 16 September 1981, he indicated he agreed with the revised findings.

14.  On 5 October 1981, the applicant was honorably discharged with severance pay by reason of physical disability.

15.  The applicant provides an Orlando Regional Healthcare, Operative Note/Procedure, dated 30 March 2000.  This document makes no mention of the specific circumstances of how the applicant's condition was incurred, however, the preoperative and postoperative diagnoses refer to his condition as "Isthmic L5-S1 spondylolisthesis with severe foraminal stenosis, early disk degeneration and retrolisthesis, L4-5."

16.  A review of the Spine-health internet website revealed the following information:

The spine condition called isthmic spondylolisthesis occurs when one vertebral body slips forward on the one below it because of a small fracture in a piece of bone that connects the two joints on the back side of the spinal segment.  The fracture in this small piece of bone, called the pars interarticularis, is caused by stress to the bone.  While the fracture tends to occur most commonly when an individual is young (around 5 to 7 years old), for most people symptoms typically do not develop until adulthood.

17.  Radiologyinfo.org, a website developed by the Radiological Society of North America and the American College of Radiology, provides the following information pertaining to myelography.

	a.  Myelography is an imaging examination that involves the introduction of a spinal needle into the spinal canal and the injection of contrast material (such as metrizamide) in the space around the spinal cord and nerve roots (the subarachnoid space) using a real-time form of x-ray called fluoroscopy.  When the contrast material is injected into the subarachnoid space, the radiologist is able to view and evaluate the status of the spinal cord, the nerve roots and the meninges (the membranes which surround and cover the spinal cord and nerve roots).

	b.  Myelography provides a very detailed picture (myelogram) of the spinal cord, nerve roots, subarachnoid space and spinal column.  Myelography is most commonly used to detect abnormalities affecting the spinal cord, the spinal canal, the spinal nerve roots and the blood vessels that supply the spinal cord.  Myelography can also be used to assess certain conditions when magnetic resonance imaging (MRI) cannot be performed, or in addition to MRI.

18.  Army Regulation 635-40 (Physical Evaluation for Retention, Retirement, or Separation) establishes the Army Physical Disability Evaluation System (PDES) and sets forth policies, responsibilities, and procedures that apply in determining whether a Soldier is unfit because of physical disability to reasonably perform the duties of his or her office, grade, rank, or rating.  

DISCUSSION AND CONCLUSIONS:

1.  The applicant's contentions have been carefully considered and determined to lack merit.

2.  In view of the fact that there were no witnesses present at the time of the applicant's injury, the statement in his medical record regarding how he incurred his injury is presumed to have been based upon information that he provided to medical personnel upon his arrival at the hospital.

3.  Contrary to his belief, the evidence clearly shows that his injury was aggravated in the LOD as the proximate result of performing his duties.  An investigation found the injury he incurred on 17 March 1981 was in the LOD.  The DA Form 2173 clearly states "when the equipment broke and fell across his back."  The LOD investigation was reviewed and subsequently approved by the proper authorities.  In view of the foregoing and in the absence of evidence to the contrary, there is no basis for correcting his record to further that show a squat rack collapsed on top of him.

4.  The applicant's contention that his condition did not exist prior to his entrance on active duty is not supported by the argument that he presented or the evidence that he provided.  His record shows he was diagnosed with "spondylolisthesis L5, S1" on or about 3 April 1981.  Approximately a month later, he underwent a metrizamide lumbar myelogram that confirmed the earlier diagnosis.  Although the applicant argues to the contrary, the radiographic report shows his spondylolisthesis was present, but showed no signs of recent occurrence.  The MEB narrative summary properly documents his spondylolisthesis and accurately reports that the myelogram did not reveal any additional abnormalities.

5.  Additionally, MEB/PEB diagnoses of EPTS are further supported by the Orlando Regional Healthcare, Operative Note/Procedure, dated 30 March 2000, that was provided by the applicant.  This document clearly identified his condition as isthmic spondylolisthesis which tends to occur most commonly when an individual is young (around 5 to 7 years old) and for most people symptoms typically do not develop until adulthood.  Although congenital spondylolisthesis is incurred at birth and isthmic spondylolisthesis most frequently occurs during childhood, both conditions would have been incurred prior to the applicant's entry into the military and both could have been aggravated by strenuous activity or a blow to the spine.  Therefore, these diagnoses are not mutually exclusive.

6.  In the absence of evidence showing the applicant's MEB/PEB documents inaccurately reflect his medical condition or the results of his metrizamide lumbar myelogram, there is no basis for correcting his record.

BOARD VOTE:

________  ________  ________  GRANT FULL RELIEF 

________  ________  ________  GRANT PARTIAL RELIEF 

________  ________  ________  GRANT FORMAL HEARING

___x____  ___x____  ___x____  DENY APPLICATION


BOARD DETERMINATION/RECOMMENDATION:

The evidence presented does not demonstrate the existence of a probable error or injustice.  Therefore, the Board determined that the overall merits of this case are insufficient as a basis to amend the decision of the ABCMR set forth in Docket Number AR20120001469, dated 11 October 2012.



      _______ _   x_______   ___
       	   CHAIRPERSON
      
I certify that herein is recorded the true and complete record of the proceedings of the Army Board for Correction of Military Records in this case.


ABCMR Record of Proceedings (cont)                                         AR20140003753





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ABCMR Record of Proceedings (cont)                                         AR20140003753



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