RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03595
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070129

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E4, Motor Transport Operator, medically separated for “chronic mid-back pain,” with a disability rating of 10%.  

CI CONTENTION: The applicant contends his back condition continues to interfere with his daily life.  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 - 20061205	VARD - 20070613	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Mid-Back Pain	5235	10%	Compression Fx of T12 with Multilevel Degenerative Changes	5235	10%	20070523	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Chronic Mid-Back Pain.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s back condition began in May 2006 after a Light Medium Tactical Vehicle, which he was driving rolled over.  He was transported to the emergency room and evaluated by orthopedics.  Radiographs (X-rays and bone scan) revealed a 30% compression fracture at T12.  He was placed in a Jewett hyperextension brace (to control and support spinal posture) for 6-8 weeks.  The orthopedic spine surgeon opined that the “CI continue use of the brace and begin physical therapy.”  Evaluation by the orthopedic surgeon recommended non-surgical treatment.  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 MEB examination (recorded on DD Form 2807 and 2808) dated October 2006, 3 months prior to separation, the CI reported that he continued to wear the Jewett brace for repetitive movement, but low back pain continued to interfere with his daily activities.   Physical exam of the back was unremarkable.  Examination revealed normal back contour, no tenderness on palpation and no spasms.  Additionally there was no loss of lumbar lordosis.  Lower extremity strength was 5/5 and equal bilaterally.  Range of motion (ROM) was 70 degrees of forward flexion (normal 90) and combined ROM of 225 degrees (normal 240).  

At the VA Compensation and Pension (C&P) examination on 23 May 2007, performed 4 months after separation, the CI reported “intermittent pain rated 8/10 in the thoracic area of his back, which radiated up to between his shoulders, described as a burning sensation.”  The CI reported the condition was aggravated by heavy lifting, bending forward or bad posture.  Physical exam showed normal ROM (forward flexion 90 degrees; combined 240 degrees) with no pain or additional limitations on repetitive testing due to weakness, fatigue, lack of endurance or incoordination.  Radiographs (X-ray) indicated a T12 compression fracture “decreased in height approximately 50%” with degenerative changes in the thoracic spine.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB and VA both assigned a 10% rating under code 5235 (vertebral fracture or dislocation), due to limitation of motion and pain by the PEB; and loss of approximately 50% vertebral height by the VA.  The Board agreed that a 10% rating, but no higher, was justified for limitation of flexion (greater than 60 degrees but not greater than 85 degrees) or decreased combined ROM reported on the NARSUM.  The VA exam finding of vertebral body fracture with loss of 50 percent or more of the height also alternatively supported the 10% spine formula 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 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 back condition.  

BOARD FINDINGS:  In the matter of the chronic mid-back pain 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 20140513, w/atchs
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 XXXXXXXXXXXXXXXXXXXX, AR20160008665 (PD201403595)

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.

Enclosure

CF:
( ) DoD PDBR
( ) DVA