RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2014-00444
BRANCH OF SERVICE:  Army	BOARD DATE:  20150219
SEPARATION DATE:  20061001

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Light Wheeled Mechanic) medically separated for low back pain (LBP).  The back condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty.  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The back condition, characterized as “chronic low back pain following L3 compression fracture and transverse process fractures at L1-L4” 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 probable application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  The applicant makes no contentions.

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:

Service IPEB – Dated 20060811	VA - (4 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain	5235	10%	L3 Compression Fracture w/ L1-L4 Transverse Fractures	5242	20%	20070214	
Other x 0  (Not in Scope)	Other x 3 	
Rating:  10%	Combined:  40%	
Derived from VA Rating Decision (VARD) dated 20070414 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Low Back Condition.  The records indicate that the CI had onset of LBP on 10 October 2005 after falling down stairs.  A CT scan that day showed an old partial compression fraction of L3 with a detached right transverse process on the right.  The CI was treated with medications, duty limitations and a back brace.  He was seen in orthopedics on 26 October 2005 and did not appear to be uncomfortable and had a normal neurological examination.  Provocative testing for nerve root irritation was negative.  On X-ray, the compression fracture was demonstrated as well as fractures of the transverse processes at L3 and L4 with degenerative changes at L2-3.  The CT was repeated on 30 November 2005 and it was noted that there was a compression fracture and transverse process fractures.  These were noted to not be acute.  X-rays the next day measured it at a 25% loss at L2-3.  This was confirmed on a magnetic resonance imaging on 20 December 2005 which noted a stable fracture unchanged from prior studies; however, it recorded a loss of approximately 50% of the height of the L3 vertebral body.  The CI continued his treatment as above, but the pain persisted.  On 22 March 2006, he was noted to have spasm and was placed on quarters for 24 hours.  X-rays were repeated on 30 March 2006 which showed no changed from the prior examinations.  He was seen that day in orthopedics which noted that the L2-3 disc space was ossifying (healing) and the use of the brace was discontinued.  The CI was cleared to resume exercise.  He continued to have pain and was recommended for a MEB on 12 May 2006.  The orthopedic addendum to the MEB was dated 6 June 2006.  The history was reviewed and it was noted that the CI had two episodes of abnormal sensations bilaterally in the lower extremities.  He did not appear to be in any distress and there was no atrophy or asymmetry of the paravertebral muscles on flexion or extension.  Flexion was 30 degrees and extension was 10 degrees.  Side bend and rotation were described as “meticulous.”  He was tender to palpation over the right paravertebral muscles, but not over the spine itself.  Four of five maneuvers not expected to produce pain in this condition were positive.  His gait and base were normal.  The neurological examination was normal.  Repeat X-rays showed a healing fracture.  At the MEB examination on 9 June 2006, the CI reported chronic LBP which was aggravated by activity.  The examiner recorded a normal gait and motor examination.  The reflexes were reduced bilaterally, but apparently symmetrically (normal variant).  He was noted to have pain with minimal movement of his back and two maneuvers not expected to produce pain were present.  The narrative summary was dated 27 June 2006 and noted the CI experienced several transient episodes of bilateral lower extremity paralysis for which there was no anatomical explanation.  He reported daily LBP with minimal activity.  It referenced the MEB examination.  He denied radicular symptoms (related to nerve root damage) and incapacitation.  He did note that he had been placed on quarters for 24 hours on two occasions while on active duty.  At the VA Compensation and Pension examination performed on 14 February 2007, 4 months after separation, the CI reported that he had worked as a cross country truck driver since 2 weeks after separation.  He reported that he could not walk or stand for over 30 minutes before he needed to sit down.  He noted that he did not load or unload trucks; however, it is not clear if this was secondary to his back, an unrelated right ankle condition, or both.  He was noted to limp, favoring the right ankle.  On examination though, the gait was normal without a limp or assistive device and he was in no acute distress.  A thoracolumbar scoliosis (curvature of the spine) was present.  There was no tenderness to palpation or spasm.  Atrophy was not present.  Provocative testing for nerve root irritation was positive at end motion, but the neurological examination was normal.  The range-of-motion (ROM) was reduced due to pain, but repetition caused no further limitation in motion.  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)	PT/MEB ~5 Mo. Pre-Sep	VA C&P ~ 4 Mo. Post-Sep	
Flexion (90 Normal)	30	50	
Combined (240)	120	165	
Comment	Signs of non-organic pain	Painful motion	
§4.71a Rating	40%	20%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the back at 10% using the 5235 code (vertebral fracture).  The VA rated the back at 20% using code 5242 (degenerative arthritis of the spine).  The ROM of the MEB examination was significantly reduced and supports a 40% rating.  However the gait was normal, pain with minimal movement was present, and pain with maneuvers not expected to be painful were present on multiple examinations.  These reduce the probative value of this examination.  On the VA examination, the gait was also noted to be normal and the CI was working as a long distance truck driver which implies minimal limitation from the back.  However, the CI did not demonstrate signs of non-organic pain on this examination and it is, therefore, assigned a higher probative value.  It supports a 20% rating for limitation in ROM.  A compression fracture was present, but supports no more than a 10% rating.  The neurological examination was consistently normal.  The evidence does not support the presence of an unfitting radiculopathy at separation.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 20% for the back condition using code 5235.

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 back condition, the Board unanimously recommends a disability rating of 20%, coded 5235 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION:  The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation:

UNFITTING CONDITION	VASRD CODE	RATING	
Chronic Low Back Pain…	5235	20%	
RATING	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140108, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

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, AR20150011001 (PD201400444)

1.  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 to modify the individual’s disability rating to 20% without recharacterization of the individual’s separation.  This decision is final.  

2.  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.   

3.  I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

 BY ORDER OF THE SECRETARY OF THE ARMY:

Encl		     

CF: 
(  ) DoD PDBR
(  ) DVA