RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03353
BRANCH OF SERVICE:  Navy 	SEPARATION DATE:  20080415

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E5, Aviation Electronics Mate, medically separated for “compression fracture T12, degenerative disc disease,” with a disability rating of 20%.  

CI CONTENTION:  Her condition continues to worsen and negatively impacts her daily activities.  Additionally, she was not evaluated for other 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 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 - 20080219	VARD - 20080728	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Compression Fracture T12, Degenerative Disc Disease	5235	20%	Thoracolumbar DDD, Status Post T11-T12 Compression Fractures 	5242	20%	20071221	
RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Compression Fracture of the Thoracic Spine with Degenerative Disc Disease. According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s back condition began in July 2003 after a fall resulting in compression fractures of the T11 and T12 vertebrae.  Evaluation by orthopedic surgery concluded there was no surgical indication and she was treated with bracing.  She recovered and returned to full duty but experienced chronic pain.  Over the course of 2007 she experienced increased back pain interfering with performance of duties and completing the physical fitness test.  At the time of the orthopedic spine clinic evaluation on 13 September 2007, the CI denied radicular or neurologic symptoms.  She reported increasing mid-back pain and difficulty with sleep.  The examiner recorded a symptomatic kyphotic deformity (increased forward bend), normal motor strength with intact sensation.  The orthopedic surgeon noted stable radiographic imaging showing healed compression fracture with associated degenerative disc disease and recommended continued non-surgical treatment.  At a physical therapy appointment on 22 October 2007, the physical therapist noted the back pain was aggravated by running and certain unsupported positions.  Thoracic flexion, extension, and rotation were noted as full.  Despite treatment, the CI’s back condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and was referred for an MEB. 

At the VA Compensation and Pension (C&P) examination on 21 December 2007, performed 4 months before separation, the CI reported stiffness and weakness with pain 4-8/10, 6-10 times a day, lasting 1 to 5 hours, brought on by physical activity.  The CI was wearing a back brace.  Physical exam showed slight kyphosis of the upper back with a normal gait, no radiating pain, muscle spasms, tenderness or ankylosis.  The thoracolumbar range of motion was forward flexion of 50 degrees (normal 90) with a combined range of motion of 195 degrees (normal 240).  

The MEB NARSUM examination on 15 January 2008 (3 months prior to separation), noted complaints of mid-back pain and muscular spasms.  The CI indicated her back pain interfered with her daily activities, exercise and prolonged sitting or standing.  The CI did not require any ambulatory aids.  The physical exam showed she was somewhat tender in her paraspinous muscles throughout the mid-thoracic and upper lumbar regions with intact sensation, normal reflexes and motor strength in all groups and bilateral lower extremities.  The range of motion examination was of the lumbar spine (versus thoracolumbar) and noted lumbar flexion of 30 degrees. 

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 20% rating under code 5235 (vertebral fracture or dislocation).  The VA also assigned a 20% rating using code 5242 (degenerative arthritis of the spine) based on the VA C&P examination 4 months before separation, citing limitation of forward flexion.  The Board agreed that a 20% rating, but no higher, was justified for limitation of flexion (greater than 30 degrees but not greater than 60 degrees) as reported on the VA examination.  The Board noted the limitation of flexion (30 degrees) reported in the MEB NARSUM suggested consideration of the next higher rating of 40%, however, the examiner specified lumbar spine and not of the thoracolumbar spine as indicated in the VASRD.  The Board noted the VA examination performed about the same time relative to separation was more detailed and compliant with VASRD rating guidelines.  Therefore the Board placed greater probative value on the VA examination.  There was no evidence of intervertebral disc syndrome resulting in incapacitating episodes requiring bed rest prescribed by a physician to warrant consideration of rating under the alternate VASRD formula based on incapacitating episodes due to intervertebral disc syndrome.  There was no evidence of an associated unfitting radiculopathy for consideration of a separate peripheral nerve 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 compression fracture of the thoracic spine with degenerative disc disease condition.

BOARD FINDINGS:  In the matter of the compression fracture T12, degenerative disc disease 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 20140717, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW
               BOARDS 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS
 
Ref:   (a) DoDI 6040.44
       (b) CORB ltr dtd 18 Apr 16

      In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for the reasons provided in their forwarding memorandums, approve the recommendations of the PDBR that the following individual’s records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy’s Physical Evaluation Board:

		- XXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXX, former USN