RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01794
BRANCH OF SERVICE:  ARMY	BOARD DATE:  20140930
SEPARATION DATE:  20031113

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty PVT/E-1 (93P/Army Aviation Operations Specialist) medically separated for a spine condition.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards.  He was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The spine condition, characterized as “spine fractures” 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 “T7, T11 vertebral compression fractures” as unfitting and rated at 20% with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  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 those conditions identified but not determined to be unfitting by the PEB when specifically requested by the CI.  The rating for the unfitting spine condition is addressed below; and, no additional conditions are within the DoDI 6040.44 defined purview of the Board.  Any conditions or contention not requested in this application, or otherwise outside the Board’s defined scope of review, remain eligible for future consideration by the Board for Correction of Military Records.

RATING COMPARISON:

Service IPEB – Dated 20031027	VA - (3 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
T7, T11 Vertebral Compression Fractures	5235	20%	Thoracic Spine, Residuals of Compression Fractures to T7 and T11	5235	40%	20040129	
Combined:  20%	Combined:  40%	
Derived from VA Rating Decision (VARD) dated 20040412 (most proximate to date of separation)

ANALYSIS SUMMARY:

Spine Condition.  Available treatment records indicate the CI was participating in organized physical training on 9 April 2003 when another service member jumped on his back.  The CI had immediate pain in his back and could not move for 5 minutes.  He was evaluated at the emergency department, placed on 48-hour quarters and treated with pain medications (Demerol injections, Lortab and Norflex).  He was admitted to Lyster Army Hospital on 14 April 2003, where he had a non-antalgic gait, normal lower extremity strength and negative testing for nerve involvement (a straight leg raise that caused back pain bilaterally at 30 degrees and seated straight leg raise that caused back pain at 70 degrees).  X-ray images demonstrated a thoracic compression fractures with decreased vertebral body heights (T7 decreased height of 62% anterior and a T11 38% anterior).  He was placed on bedrest and air evacuated to Ft. Gordon, Georgia for further evaluation by a spine surgeon.  He was treated in an extension back brace for 6 months.  The back pain persisted.  He received an L3 profile for spine fractures and was referred to the MEB.  

The narrative summary dated 2 October 2003 noted chronic mid-back pain, but no pain medications.  He had no neurological symptoms.  The physical examination revealed a spine mildly tenderness to palpation in the thoracic area, but no redness or swelling.  He had a nonantalgic gait with normal bilateral lower extremity strength and sensation.  Straight leg raise testing for nerve involvement was negative.  Deep tendon reflexes were normal.  X-ray images performed in October 2003 showed no progression of kyphosis (hunched posture), a decreased height of T7 at 58% and T11 to 62%.  A diagnosis of T7 and T11 vertebral compression fractures was rendered.  The orthopedic surgeon opined there was no indication for surgery.  Pain ratings were slight and frequent.

At the VA Compensation and Pension (C&P) general medical examination (performed 3 months after separation), the CI reported the member who fell on his back weighed over 200 pounds and fell while CI was bent over.  CI had not been able to find a job since separation.  He reported his back was “killing him.”  He could not sit for long periods of time.  He reported that the pain increased with walking after 250 yards.  He could not run.  He could walk one flight of stairs, but pain was worse going up.  If he jars his body, e.g. accidently stepping off curb, he has immediate back pain.  He could no longer ski, play basketball or football or hang glide.  The pain was 4/10 and the pain level rose to 10 after constantly bending.  At this level movement in any direction caused pain.  By the end of the day he had to go to bed and required medication for sleep.  He previously used hydrocodone, but it made him drowsy and worked as well as Motrin.  Physical examination of the thoracic spine showed tenderness along the entire thoracic spine and muscle spasms when sitting partially bent over.  The lumbar spine was very tender to percussion.  Forward flexion was limited to 45 degrees and extension to 20 degrees.  Lateral flexion was full to 30 degrees bilaterally, although he had pain between the shoulder blades as he reached down.  He could perform rotation.  X-ray images of the thoracic spine revealed a mild rotoscoliosis (abnormal curving of the spine like an “s”) with 25-30% anterior compression of the body of T7.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB adjudicated the T7, T11 vertebral compression fractures, forward flexion 50 degrees as unfitting with a disability rating of 20% coded 5235, vertebral fracture or dislocation.  The VA rated the thoracic spine, residuals of compression fractures T7, T11 with a disability rating of 40%, coded 5237.  The Board considered whether criteria for a higher than the PEB’s 20% rating had been met under VASRD codes 5235 (vertebral fracture or dislocation).  The Board first considered coding options noting that the Informal PEB and VA appropriately used the same code 5235 (vertebral fractures).  Under this code a 20% rating requires forward flexion of the thoracolumbar spine greater than 30 degrees, but not greater than 60 degrees; or, the combined range-of-motion of the thoracolumbar spine not greater than 120 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis.  The PEB rating of 20% is supported by the thoracolumbar flexion of 45 degrees.  No evaluation in evidence supports a 40% rating, which would require forward flexion of the thoracolumbar spine 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine.  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 T7, T11 condition.  The Board concluded therefore that this condition could not be recommended for additional disability rating.

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.  In the matter of the T7, T11 vertebral compression fractures 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.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140423, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

XXXXXXXXXXXXXXXXXX
President
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 XXXXXXXXXXXXXXXXXX AR20150006351 (PD201401794)

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						     XXXXXXXXXXXXXXXXXX
						     Deputy Assistant Secretary of the Army
						          (Review Boards)
						         
CF: 
(  ) DoD PDBR
(  ) DVA