RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX		CASE:  PD-2014-02952
BRANCH OF SERVICE:  AIR FORCE		SEPARATION DATE:  20011106 

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Security Forces Apprentice, medically separated for “chronic low back pain” with a disability rating of 10%.  

CI CONTENTION:  His back pain continually disrupts his daily activities.  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 confined to 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 – 20010926	VARD - Service Treatment Records (STR)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Low Back Pain with L1 Compression Fracture	5295	10%	Compression Fracture, L1 with Chronic Low Back Pain	5299-5295	10% 	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITION:  10%	

ANALYSIS SUMMARY:  

Lumbar Spine Condition.  The service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM) documented a back injury (axial load) from a vehicular accident in August 2000 (15 months pre-separation).  Although X-rays were normal, a vertebral compression fracture (L-1) was suspected by examination and was confirmed by a subsequent bone scan.  The CI suffered persistent pain which did not adequately respond to conservative treatment and surgical intervention was not indicated.  There was no STR evidence for radicular symptoms and multiple neurological examinations were normal (none to the contrary).  Some outpatient STR entries documented non-specifically decreased (one estimating 5% reduction) range of motion (ROM) and painful motion.  There were no entries which suggested severe ROM limitation, significant spasm or abnormal spinal contour, gait disturbance, or prostrating attacks of pain.

The NARSUM was conducted 20 August 2001 (2 months pre-separation) and documented persistent lumbar pain, possibly attributable to the compression fracture, requiring a protracted profile as a “poor prognostic indicator.”  The NARSUM physical examination recorded “exquisite tenderness at L1-L2 ... pain on extension ... [and] ... spinous spasm,” with normal neurological findings (5/5 strength).  A subsequent STR clinical entry (5 weeks pre-separation) documented grossly normal ROM (with spasm), a normal gait, and normal neurologic findings.  The CI failed to report for a scheduled VA examination, and there was no temporally probative VA post-separation evidence.

The Board directed attention to its rating recommendation based on the above evidence.  The 2001 VASRD coding and rating standards for the spine, which must be applied to the Board’s recommendation IAW DoDI 6040.44, differ significantly from the current §4.71a general rating formula for the spine.  The applicable coding and rating options for this case are excerpted below. 
5292 Spine, limitation of motion of, lumbar
Severe ...................................................................................................................................... 40	
Moderate ................................................................................................................................. 20		
Slight ........................................................................................................................................ 10
          5295 Lumbosacral strain:
Severe; with listing of whole' spine to opposite side, positive Goldthwaite's sign, 
marked limitation of forward bending in standing position, loss of lateral motion 
with osteo-arthritic changes, or narrowing or irregularity of joint space, or some
of the above with abnormal mobility on forced motion ...................................................... 40
With muscle spasm on extreme forward bending, loss of lateral spine motion, unilateral,
 	          in standing' position ............................................................................................................. 20
With characteristic pain on motion ......................................................................................... 10      
          5285 Vertebra, fracture of, residuals:
             ...    In other cases rate in accordance with definite limited motion or muscle spasm, adding 10 
                    percent for demonstrable deformity of vertebral body.

The PEB’s 10% rating under code 5295 was supported by the evidence, and criteria for the higher ratings under that code were not in evidence.  The VA’s 10% rating analogous to the same code and based on the same evidence cited characteristic painful motion and the absence of the higher rated criteria.  Members thus agreed that no higher rating under 5295 could be recommended, and further agreed that alternate rating under 5292 would be to no advantage given the ROM evidence.  There was no evidence for consideration of additional rating for spinal neuropathy.  Although both the PEB and VA acknowledged the contribution of the vertebral compression fracture in their condition nomenclature, neither pursued additional rating under code 5285 as above.  Members deliberated whether a separate 10% rating under 5285 could be fairly recommended.  Members agreed, however, that the “demonstrable deformity” criterion was not satisfied since there was no radiographic deformity in this case, only bone scan detection of a healing fracture.  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 of the lumbar spine condition.  

BOARD FINDINGS:  In the matter of the lumbar spine 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.  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 20140616, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAF/MR
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD  20762

Dear XXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2014-02952.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate.  Accordingly, the Board recommended no re-characterization or modification of your separation.

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  Accordingly, I accept their recommendation that your application be denied.

Sincerely,

Attachment:
Record of Proceedings