RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00896
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20040421

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E2, Radio and Communications Security Repairer, medically separated for “chronic back pain, status post treated osteomyelitis of the lumbar and sacral spine secondary to MRSA [methicillin-resistant staphylococcus]” with a disability rating of 20%.

CI CONTENTION:  He has been unable to work and walks with a cane and sometimes uses a wheelchair.  The VA rated him 100% for his condition.  The complete submission is at Exhibit A.

SCOPE OF REVIEW:  The panel’s scope of review is defined in DoDI 6040.44.  It is limited to review of disability ratings assigned to those conditions determined by the Physical Evaluation Board (PEB) to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the Medical Evaluation Board (MEB), but determined by the PEB to be not unfitting or non-compensable.  Any conditions outside the panel’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 Records.  The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence relevant to application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards for the unfitting medical condition(s) at the time of separation.  The panel 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, which operates under a different set of laws.  The panel gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of disability at the time of separation.  

RATING COMPARISON:

SERVICE PEB - 20040318	VARD - 20050126	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Back Pain status post Osteomyelitis of Lumbar and Sacral Spine secondary to MRSA	5002	20%	Osteomyelitis of the Lumbosacral Spine, Left Sacroiliac Joint and Left Hip	5000	100%	20041207	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  100%	

ANALYSIS SUMMARY:

Chronic Back Pain and Osteomyelitis of the Lumbar and Sacral Spine.  According to the service treatment record (STR) and the MEB narrative summary (NARSUM), the CI’s back pain condition began in April 2003 after reaction to the anthrax vaccination.  An infection complication originating from another medical condition resulted in a bone infection (osteomyelitis) of the lumbosacral spine which worsened the CI’s low back pain.  Despite aggressive treatment of the osteomyelitis, the back pain condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for MEB.

At the MEB NARSUM examination on 01 December 2003, 5 months prior to separation, the CI’s reported low back pain.  Physical examination revealed tenderness over the left sacroiliac joint and “limited range of motion (ROM) in flexion and extension of back;” painful motion was not addressed.  His diagnoses included chronic LBP and a prior episode of bacteremia (systemic infection) that resulted in osteomyelitis of the lumbar and sacral spine which were previously treated as noted by documentation on the DA Form 199 stating, “Chronic back pain, status post treated osteomyelitis of lumbar and sacral spine.”  During the 30 January 2004 physical therapy visit, 3 months prior to separation, thoracolumbar repetitive ROM as flexion to 45 degrees (normal 90) and combined ROM could not be measured; painful motion was present.

At the 07 December 2004 VA Compensation and Pension (C&P) examination, performed 8 months after separation, the CI reported low back pain that extended into his left leg.  Physical examination revealed an antalgic gait (left leg limp) and use of a cane.  There was spinal muscle spasm and tenderness.  ROM was flexion to 40 degrees and combined ROM was 140 degrees (normal 240) with painful motion.  There was diminished left leg sensation to pinprick and vibratory stimulation.  The examiner’s impression was “Osteomyelitis of the lumbosacral spine, left sacroiliac Joint, and left hip with status post sustained antibiotic treatment with continued back pain, hip pain, and sacroiliac pain.”  During the 07 April 2005 bone marrow imaging, 12 months after separation, the examiner’s impression was increased white cell activity in the pelvis most likely represents normal bone marrow.  Osteomyelitis is very unlikely.

The panel directed attention to its rating recommendation based on the above evidence.  Panel members first considered and agreed that the PEB’s overall listed diagnostic condition included that of three separate conditions to include:  low back pain, spinal osteomyelitis, and methicillin-resistant staphylococcus aureus (MRSA; a systemic bacterial infection).  Due to the CI’s systemic bacterial infection (which was eventually cured well before separation), the CI’s low back pain is best considered a resultant-residual condition.  Although the two preceding pathological conditions of spinal osteomyelitis and methicillin-resistant staphylococcus) which contributed to the CI’s chronic low back pain condition were resolved and only historically noted, any potential additional symptoms or adverse findings from such conditions were subsumed under the general spine rating criteria.

The PEB rated the low back condition 20%, coded 5002 (arthritis rheumatoid).  The VA rated the back condition 100% coded 5000 (osteomyelitis, acute, subacute, or chronic), based on the C&P evaluation 8 months after separation, citing the examination showed osteomyelitis in the lumbosacral spine, left sacroiliac joint, and left hip.  The panel noted the C&P examination did not test for staphylococcal in the CI’s lumbosacral spine, left sacroiliac joint, and left hip.  The VA referenced the CI’s STR X-ray imaging which revealed L4/L5 and L5/S1 bone deterioration; the sacroiliac joint and let hip were not addressed.  Additionally, the VA referenced the spinal osteomyelitis and methicillin-resistant staphylococcus diagnoses and treatment the CI received while in service.

The panel agreed that a 20% rating, but no higher, was justified for limitation of flexion (greater than 30 degrees but not greater than 60 degrees) as reported by the physical therapy examination 2 months prior to separation and the VA examination at 8 months after separation.  The panel concluded that there was no evidence to support a rating higher than the rating adjudicated by the PEB.  Additionally, panel members agreed that there was no evidence of intervertebral disc syndrome (IVDS) which resulted in incapacitating episodes requiring physician-prescribed bed rest to warrant consideration of rating under the alternate VASRD formula (for IVDS) nor was there sufficient evidence of an associated unfitting radiculopathy for consideration of a separate peripheral nerve rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB’s adjudication for the chronic back pain condition.

BOARD FINDINGS:  In the matter of the chronic back pain condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  There were no other conditions within the panel’s scope of review for consideration.  Therefore, the panel recommends no modification or re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160919, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20180005779, XXXXXXXXXXXXXXXXXX  

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction.

Sincerely,					      
Enclosure