RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02884
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090930

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a National Guard E5, Motor Transport Operator, medically separated for “vertebral fracture T12,” with a disability rating 10%.  

CI CONTENTION:  “Please consider all conditions.”  The CI’s complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited 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 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 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 based upon a review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (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 PEB - 20090608	VARD - 20100514	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Vertebral Fracture T12	5235	10%	Status Post Fracture, Thoracolumbar Spine	5237	10%	20091104	
Episodic Cervicalgia	Not Unfitting 	Neck Condition	5235	NSC		
Bilateral Wrist Tenosynovitis		Bilateral Wrist Condition	5215			
Bilateral Knee Arthralgia		Bilateral Knee Condition	5260			
Major Depression		Post-Traumatic Stress Disorder	9411			
Anxiety Disorder, NOS						
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Vertebral Fracture T12.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI had a long history of back pain with exacerbation from a traumatic injury in September 2006, after he fell during a rappelling mishap.  

Radiographic studies obtained in 2006 showed fractures of the T9 and T12 levels of the vertebrae.   Magnetic resonance imaging (MRI) studies demonstrated degenerative changes in vertebral discs of the lower spine.  Evaluation by orthopedics recommended non-surgical treatment.  Despite conservative treatment, the back condition could not be adequately rehabilitated to meet the physical requirements of CI’s military specialty and the CI was referred for a MEB.  The MEB forwarded “chronic lumbago with T12 compression fracture” for PEB adjudication.

At the MEB examination (recorded on DD Form 2807 and 2808) dated 13 January 2009 (9 months prior to separation) the CI reported low back pain without radiation symptoms.  Provocative testing for nerve root irritation was negative.  Strength, sensation, and reflexes were normal, and the CI had full range of motion (ROM) of the back.

The MEB NARSUM examination on 16 January 2009 recorded complaints of repeated pain in the low and upper left areas of his back.  The CI denied leg pain as well as bowel and bladder symptoms, and indicated he could walk approximately one-half mile and stand for one-half hour, but could not run, ride a bicycle, or play sports.  Physical examination revealed non antalgic gait and negative results for provocative maneuvers for nerve root irritation.  At a separate physical therapy (PT) examination later that same day, recorded ROM forward flexion 91 degrees (normal 90) and 95 degrees after 3 repetitions.  He achieved a combined ROM of 180 degrees (normal 240).  Painful motion was observed during extension and lateral movements of the thoracolumbar spine.

The orthopedic examination on 30 March 2009 (6 months prior to separation) reported complaints of pain primarily in the lumbar area (the lower back) with no radiation of pain, numbness, or weakness in the lower extremities.  The CI denied bowel or bladder symptoms.  On examination, the CI transitioned easily between sitting and standing.  ROM was documented as “with knees extended, he is able to forward flex and touch his ankles (90 degrees).”   He was noted to have pain with terminal flexion and extension.

At the 4 November 2009 VA Compensation and Pension (C&P) examination, performed 1 month after separation, the CI reported upper back pain with bending or twisting.  The CI denied symptoms of neuropathy and evidence of neuropathy was absent during the neurological examination.  There was no loss of motor strength, sensation, or reflexes.  ROM of the thoracolumbar spine documented flexion to 70 degrees and extension to 20 with pain on motion.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the vertebral fracture T12 condition 10%, coded 5235 (vertebral fracture or dislocation), citing painful range of motion.  The VA also rated the condition 10%, but coded 5237 (lumbosacral strain), based on ROM.  The Board agreed that a 10% rating, but no higher, was justified for the presence of painful motion as reported on all examinations proximate to separation.  Additionally, while not supported on other examinations, limitation of flexion (greater than 60 degrees but not greater than 85 degrees) reported at the VA examination (most proximate to separation) also supported a 10% disability rating.  There was no muscle spasm or guarding severe enough to result in abnormal gait or spinal contour, thus the next higher 20% rating was not justified on this basis.  There was no documentation of intervertebral disc syndrome with incapacitating episodes which would provide for a higher rating under that formula, or evidence of ratable peripheral nerve impairment which would provide for additional rating.  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 vertebral fracture condition.  

Contended PEB Conditions:  Episodic Cervicalgia, Bilateral Wrist Tenosynovitis, Bilateral Knee Arthralgia, Major Depression Recurrent, and Anxiety Disorder NOS.   The Board’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  None of the conditions were profiled or implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that any of the conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the vertebral fracture T12 condition, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended episodic cervicalgia, bilateral wrist tenosynovitis, bilateral knee arthralgia, and mental health conditions, the Board unanimously recommends no change from the PEB determinations as not unfitting.  There were no other conditions within the Board’s scope of review for consideration.  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 20140515, w/attachments
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 
XXXXXXXXXXXXXXXXXX, AR20160017019 (PD201402884)

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