RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	 CASE:  PD -2014-02509
BRANCH OF SERVICE:  Army	Separation Date:  20080428

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Basic Trainee) medically separated for a thoracic spine vertebral fracture.  This condition could not be adequately rehabilitated to allow the CI to complete basic training, so she was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The “chronic low back pain secondary to T12 compression fracture” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501, no other condition was submitted by the MEB.  The informal PEB adjudicated “Vertebral fracture…of T12…” as unfitting, rated 20%, citing application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.  

CI CONTENTION:  She was not evaluated for any additional conditions related to her spine injury.  His complete submission is at Exhibit A.”

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:  

PEB – Dated 20080328	VA* - (~5 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Vertebral Fracture…T-12	5235	20%	…Compression Fracture, T-12…	5299-5239	10%	20081008	
Other x 0 	Other x 1	
RATING:  20%	RATING:  10%	
*Derived from VA Rating Decision (VARD) dated 20090203 (most proximate to date of separation (DOS)).  

ANALYSIS SUMMARY:  

Back Condition.  The CI sustained a T12 compression fracture on 2 October 2007 during Basic Training.  She was hospitalized for 4 days and placed in a thoracolumbosacral orthotic (TLSO) brace.  Both the thoracic and lumbar spine X-rays showed a T12 compression fracture.  An MRI done during the hospitalization showed a mild compression deformity of T12 with bone marrow edema (swelling) which was consistent with an acute injury.  The Orthopedist in February 2008 noted that despite 90 days of convalescent leave, the CI was still having back pain.  

The MEB Narrative Summary (NARSUM) exam approximately 2 months prior to separation documented that the CI had constant low back pain and was not able to return to training.  Her constant pain was rated at 5/10 and increased to 9/10 with a change in the weather and any kind of physical activity.  She required a non-steroidal anti-inflammatory medication (NSAID) daily for pain control.  The CI reported that because she was a physical therapist (PT) that she had been doing range-of-motion (ROM) exercises on her own.  Prognosis was for symptoms to not resolve over a 1-year period.  The MEB NARSUM physical exam findings are summarized in the chart below.

The VA Compensation and Pension (C&P) exam approximately 5 months after separation documented that the CI had intermittent throbbing back pain that was constant some days.  She had cold weather induced flares which caused her back to be more painful and stiff.  She required a strong narcotic and NSAID to control the pain.  Her functional impairments were an inability to lift, pull, push or carry and an inability to sit for more than 20 or 30 minutes.  The VA C&P physical exam findings are summarized in the chart below.  MRI documented a mild compression fracture at T12 without cord impingement or cord edema and a small central disc protrusion at L5-S1.  

There were ROM evaluations in evidence, with documentation of additional ratable criteria, which the Board weighed in arriving at its rating recommendation; as summarized in the chart below.  

Thoracolumbar ROM
(Degrees)	PT ~3 Mo. Pre-Sep	MEB ~2 Mo. Pre-Sep	VA C&P ~5 Mo. Post-Sep	
Flexion (90 Normal)	45	MEB used ROM’s from PT	70	
Extension (30)	15		30	
Combined (240)	150	150	205	
Comment	Painful motion; tenderness to palpation (TTP); normal gait 	Painful motion; + straight leg raise (SLR) bilaterally; TTP along T12 spinous process; sensory/reflexes nml	Painful motion; - SLR; normal gait, + TTP; no spasm; normal sensory/strength/reflexes 	
§4.71a Rating	20%	20%	10%	

The Board directed attention to its rating recommendation based on the above evidence.  The PEB coded the back condition as 5235 (Vertebral fracture or dislocation) and rated at 20%.  The VA coded the back condition as 5299 analogous to 5237 (Lumbosacral strain) and rated at 10%.  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 general spine formula rates the thoracolumbar spine as a single segment and considers all thoracolumbar abnormalities (including any disc protrusions as contended and noted on VA MRI) for disability rating.  The Board adjudged that the MEB exam was closer to separation; the ROM’s performed by a PT was coupled with the NARSUM and was the most detailed exam and therefore had the higher probative value for rating at separation.  The CI met the 20% rating criteria of “Forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees.”  There was no evidence proximate to separation of forward flexion limited to 30 degrees or less, or ankylosis of the thoracolumbar spine for any rating higher than 20%.  There was no non-pain radiculopathy for consideration of any additional peripheral nerve rating.  There were insufficient periods of incapacitation (physician prescribed bed rest for at least 4 weeks) for any higher alternate rating under the formula for rating intervertebral disc syndrome based on incapacitating episodes.  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 back condition.  

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 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 and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140531 w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR Commander

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXXXXXXXX, AR20160004997  (PD201402509)

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:

 

Enclosure 

CF:

(  ) DoD PDBR 
( ) DVA